SUMMER Student Programs Reservation Request 2022

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2022 RPSEC SUMMER GROUP PROGRAMS
RESERVATION REQUEST

TEACHER INFORMATION

Teacher’s Name*

First Name

Last Name

Birthdate (mm/dd)*

Last four digits of SS#*

Home Phone*

Cell Phone

E-mail Address:*

Confirmation Contracts and Program Reminders will be sent via e-mail. Please provide an address you check on a regular basis.

SCHOOL / ORGANIZATION INFORMATION

School/Organization*

School/Organization Mailing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

School/Organization Phone*

PROGRAM REQUEST INFORMATION

Age of Students*

Number of students visiting: (10 min, 90 max)*

Check ONE to indicate how many programs you want to participate in during your visit. *

1 program: Max 30 Students - If more, you must select 2 programs. 2 programs: Max 60 Students - If more, you must select 3 programs. 3 programs: Max 90 Students

Groups of 10 to 30 students

-Plan to select one, two, or three programs per visit. Programs are 1 hour long.

Groups of 31 to 60 students

-Must select two or three programs with only ONE planetarium program.

-Your visit will be approximately 3 hours/2 programs or 4 hours/3 programs (includes 30 minute lunch break).

Groups of 61 to 90 students

-Must select three programs with only ONE planetarium program.

-Your visit will be approximately 4 hours (includes a 30 minute lunch break).

Program 1

Max 90 Students

Program 2

Max 90 Students

Program 3

Max 90 Students

Special Education Needs ( Please explain )

TEACHER INFORMATION

SCHOOL / ORGANIZATION INFORMATION

PROGRAM REQUEST INFORMATION

SCHEDULING INFORMATION