Discovery Days at the Lab Application for 2018-19

Is this application for a Title I School? (required)
YesNo

Point of Contact First Name (required)

Point of Contact Last Name (required)

Point of Contact Title (required)

School/Organization (required)

Street Address (required)

City (required)

State (required)

Zip (required)

County (required) Note: we follow your county's cancellation policies for inclement weather

Telephone (required)

Email (required)

Requested Dates (optional) Select 6 dates in order of preference, Mondays through Thursdays, September 2018 through April 2019 We will do our best to accommodate your first request. Dates are not required to apply for this program.

Grade Level?

How many visits does your school's grade level require?


Submission of this form indicates that the school or organization agrees to the following (please mark each box on the left to each item to signal understanding and compliance)

I Understand that only Title I schools in the Northern Virginia region are eligible to apply for the Discovery Days at the Lab program.

I Agree to not permit food or beverages in the Lab.

I Understand that Discovery Days at the Lab are only scheduled on Mondays through Thursdays from 10:00am – 12:00 pm or 12:00 – 2:00 pm, September 2018 through April 2019.

I Acknowledge that the Children's Science Center often uses photographs, videotapes, television programs, motion pictures, tape recordings, or other similar media for promotional purposes. I hereby consent to the use of my group's name and/or likeness in such materials to be exhibited and used for advertising, trade purposes, solicitation of patronage, promotional purposes, or other similar purposes. I waive any right to inspect or approve the finished version(s), including written copy that may be created in connection therewith. This consent is expressly intended to release the Children's Science Center from liability. Students or chaperones who do not wish to have their photos or likenesses recorded should notify the Children's Science Center when they arrive at the Lab.

I Agree to provide a minimum of 8 weeks notice prior to cancelling or requesting to reschedule a visit. I understand that not all requests to reschedule a visit can be accommodated.

I Agree to participate in one or more of the communications activities outlined in the program description.

FAILURE TO COMPLY WITH THESE CONTRACTUAL OBLIGATIONS CAN LEAD TO A FORFEITING OF YOUR SCHEDULED GROUP VISIT, OR INELIGIBILITY TO PARTICIPATE IN FUTURE EVENTS OR GROUP VISITS.


By submitting this form, the point of contact agrees to be the responsible party for the obligations outlined in this agreement. In this web form, your typed signature is treated by the Children's Science Center like a physical handwritten signature on a paper form.

Full Name of Responsible Party (Will serve as your signature)

Signature Date