Program Request Form

School/Group Name*

Number of Children*

Number of Classes*

Age Range of Children*

Requested Program Date*

If you would like to book more than one date, please list them in the "additional questions/comments" section below.

Special Needs

The Museum's priority is to make educational programs accessible to all students. We ask that you please share any special needs your students may have ahead of time so that we can accommodate their needs and help offer appropriate programs.

Requested Start Time*

:

Program Grade*

Select all that apply.

Preschool Programs*

Check each one you are interested in.

School Aged Programs*

Check each one you are interested in.

Contact Person*

Address*

Telephone (day)*

Email*

Payment Source*

For example: BOCES, PTA, school business office, etc.

Additional Questions/Concerns

For example: questions about payment, scheduling conflicts, etc.

Regular Museum hours:

9:00am to 12:00pm

and

1:00pm to 4:00p

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The Children's Museum