Teacher/Group Leader’s Name: Grade Level or Age Group School/Group Name: School System: Mailing Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip / Post Code Phone (work) Phone (cell) Email Please contact me by: EmailPhone If by phone, what is the best time of day to reach you? Preferred Visit Date: Preferred Visit Date #2: Preferred Visit Date #3: Earliest arrival time and latest departure time: Number of students: Number of teachers: (1:10 ratio) Additional adults (bus drivers complimentary): Any special needs? If so, please explain in detail. Check all programs desired: EXHIBIT FLOOR (Includes How It Works, Healthy Bodies, Healthy Earth, Changing Exhibit Gallery)MUSEUM STORELIVE ANIMAL DEMONSTRATIONBUTTERFLY GARDEN (Included for contracting school districts ... additional charge for all others.)ROCK SLUICE ($6/bag ... no sharing)IN-MUSEUM SCIENCE CLASS/LAB (See website for programs. Included for contracting school districts ... additional charge for all others.) IN-MUSEUM SCIENCE CLASS/LAB desired (if applicable). CLICK DOWN ARROW FOR LIST OF CLASSES/LABS PreK-GRADE 1: Animal Sense PreK-GRADE 1: The Five Senses PreK-GRADE 1: Science Toys PreK-GRADE 2: Animal Needs GRADE 1-5: Dig It! GRADE 1-4: Habitats GRADE 2-3: Physical Properties and Physical Changes of Matter GRADE 2-5: Wildfire GRADE 3-4: Food Chains GRADE 3-5: Super Ball Science GRADE 3-5: Adaptations GRADE 5: Amazing Light MIDDLE SCHOOL: Food Chain MIDDLE SCHOOL: Adaptations MIDDLE SCHOOL: Genetics MIDDLE SCHOOL: Eye to Eye (additional cost applies) MIDDLE SCHOOL: Discover DNA MIDDLE SCHOOL: Wet all over: Watersheds and Aquatic Ecosystems MIDDLE SCHOOL: Natural Selection and Adaptations MIDDLE SCHOOL: Classify This! MIDDLE SCHOOL: All Keyed Up: Dichotomous Keys in Action ALL AGES: Planetary Journey: A Tour of the Solar System ALL AGES: Sky Stories - Astronomy and Mythology of the Constellations ALL AGES: Earth and the Moon - Past, Present, and Future ALL AGES: Exploring Mars Do we need to incorporate time into your schedule to eat lunch? Are you planning to eat lunch at the museum and require space? ($20 fee) Are you planning to eat lunch offsite? If you plan to visit any other area attractions, please let us know what time. ALL REQUESTS MUST BE SUBMITTED IN WRITING, USING THIS FORM. Forms should be submitted a minimum of 4 weeks prior to requested visit ... 6-8 weeks if requesting a visit during our peak months of April and May. You have a reservation only if you have received a confirmation by email. Please bring the confirmation with you the day of your visit. The Science Museum of Western Virginia is open for school groups Monday-Friday from 9:30 AM to 5:00 PM. Exhibits, in-museum classes, and labs are available for scheduled groups during these hours. You must reserve in advance in order to receive the group rate. We require 1 adult chaperone per 10 students; additional adults pay the group rate. Regarding any questions or concerns, please contact the Science Museum's Scheduler at 540-342- 5721 or email email@example.com. We will respond to your inquiries as soon as possible. We look forward to your visit!