Museum Pop-Up K-5 Reservation Request

School/Organization/Group Information

School/Organization/Group Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Information

Contact Person*

First Last

Contact Person Title

Contact Phone*

Contact Email**

Request Information

Grade Level(s)**

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

Number of Students Expected to Attend**

Total Expected Attendance**

Choose Your Pop-Up Bundle(s). Note: Each bundle is $350 and subject to availability.**

Amazing Animals

Flying Machines

Getting Loud

Marvelous Magnets

Science of Structures

Requested Date (1st Choice)**

Requested Date (2nd Choice)

Requested Time**

Will the DCM Facilitator have access to electricity?**

Yes

No

Not Sure

Will the DCM Facilitator have access to Wifi?**

Yes

No

Not Sure

Additional Questions/Requests

Do you have any additional questions or requests?