| Please complete one application for each class. |
|
School Name:_____________________________________________
|
| School Board:_____________________________________________
|
| School Address:___________________________________________
|
|
City:______________ Province:__________
Postal Code:___________
|
| Telephone Number:______________________ (Please indicate Area Code)
|
| Fax Number:_____________________ (Please indicate Area Code)
|
| Teacher's Name_____________________________________
|
Requested Date of Visit
(Day/ Month/ Year)
1st Choice_____________________________ AM PM
2nd Choice_____________________________
AM PM
|
Estimated time of Arrival/Departure
Estimated time of Arrival _______________________
Estimated time of Departure _____________________
|
Program Choices
(Please list your preference and two alternate choices)
1st _______________________________
2nd _______________________________
3rd _______________________________
|
| Total number of programs for this group: _______
|
Grade:_______
Number of Students: (maximum of 35)_______
Number of Chaperones:_______
|
| Language of Program: ( ) English ( ) French
|
| Special Needs: __________________________________________ ______________________________________________________
( ) Physically Challenged ( ) Developmentally Challenged
( ) ESL ( ) FSL
Method of Payment: ( ) Cash ( ) Cheque
|
Program Fees
(All fees are per student)
| Regular Programs: |
$5 |
| Special Programs: | |
| Curriculum Days |
$6 |
| Summer Fun Days | $6 |
| Biotechnology Days | $6 |
Please enquire about group rates for the Virtual VoyagesTM simulator.
* Due to the special nature of this program, groups must have a minimum of one adult supervisor per 10 students; maximum group size: 25 participants (larger groups can be split).
Return form to:
Canada Science and Technology Museum Reservation Office
P.O. Box 9724, Station T
Ottawa, ON
K1G 5A3
Telephone (613) 991-3053 or
Toll Free 1-866-442-4416
Fax (613) 993-7923
Due to space limitations, we cannot guarantee programs. Confirmation of your scheduled program will be mailed to you.
|
