IMPRESSION5

Week-Long/Full Day Camp

Cost: $295/Member $375/Not-yet Member

Read more about Summer L.A.B.S. Registration

Event Rental Inquiry

"2017-04-17","2017-04-10","2017-05-29"

Name of Contact *

Company or Organization

Address

Contact Phone Number *

Email *

Date of Rental *

Year

Month

Day

Start Time of Rental *

Start Time of Rental am/pm Option *

am

pm

End Time of Rental *

End Time of Rental am/pm Option *

am

pm

Describe any specific needs for your event :

Type of Event

Will food and alcohol be served?

Yes

No

# of Anticipated Children

# of Anticipated Adults

CAPTCHA

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Emergency Release Form

Child's Name *

Date of Birth *

Year

Month

Day

Child's Address *

City *

State *

Zip *

Parent’s/Guardian’s Name *

Phone No. *

Parent’s/Guardian’s Name

Phone No.

Additional Emergency Contact *

Phone No. *

Additional adults who may pick up my child from Impression 5

Insurance Company

Insurance Number

Allergies

Comments (please continue on back if necessary)

PHOTO RELEASE:
Impression 5 will routinely publish in print, electronic, or video format the likeness or image of children
enrolled in L.A.B.S. Programs in conjunction with Impression 5 programming and publicity.

PHOTO RELEASE OPTION *

YES, I release my child’s likeness.

NO, I do not release my child’s likeness.

I hereby authorize Impression 5 Science Center to seek emergency treatment for the child indicated above in the event I cannot be reached. I give my permission for him/her to participate in all activities in the Science Center as part of the described programs.

Parent/Guardian Signature *

Printed Name *

Date *

Year

Month

Day

Read more about Emergency Release Form

Donate

Read more about Donate

School/Science Center Partnership Program Request

"2017-04-17","2017-04-10","2017-04-29"

Type of Program *

Big Science Lesson

Generation Science

Group Name *

Date *

Year

Month

Day

Arrival Time *

Arrival Time Option *

AM

PM

Departure Time *

Departure Time Option *

AM

PM

Grade/Age

Approximate # of Students *

Approximate # of Teachers *

Approximate # of Chaperones

Name of Group Contact *

Email *

Phone Number of Contact Person (work) *

Additional Phone Number of Contact Person (home/cell)

Address for Invoice

CAPTCHA

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Read more about School/Science Center Partnership Program Request

Scholarship

Read more about Scholarship

Outreach Request

"2017-04-17","2017-04-10","2017-04-29"

Outreach *

Educational Outreach (workshop fee based)

Promotion Outreach (fee varies)

Educational and Promotion (fee varies)

First Choice Day/Date *

Year

Month

Day

Second Choice Day/Date

Year

Month

Day

Event Start Time *

Event End Time *

Group/Organization Name *

Grade/Age

Approximate # of Students *

Approximate # of Adults *

Name of Group Contact *

Organization Address

Same as Above

Event Address *

Email *

Phone Number of Contact Person (work) *

Day of Event Contact Person Number (cell) *

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Evening Adventure Request

"2017-04-17","2017-04-10","2017-05-23"

Evening Adventure *

Evening Adventure (6 p.m. - 9 p.m.)

First Choice Day/Date *

Year

Month

Day

Second Choice Day/Date

Year

Month

Day

Group Name *

Grade/Age

Approximate # of Students *

Approximate # of Teachers *

Approximate # of Chaperones *

Name of Group Contact *

Email *

Phone Number of Contact Person(work) *

Additional Phone Number of Contact Person (home/cell)

Address for Invoice

Workshop Requested

Young Child Workshop - 5 & Younger

Workshops - 5 & Up

Young Child Workshop

Magnets Junior $1

Biospheres Junior $2

Numbers! $2

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Read more about Evening Adventure Request

Home Page Blocks Settings

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Shopping cart

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Summer L.A.B.S. Registration

Event Rental Inquiry

Emergency Release Form

Donate

School/Science Center Partnership Program Request

Scholarship

Outreach Request

Evening Adventure Request

Home Page Blocks Settings

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Impression 5
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