Survey/Form Review
GCC Science Center Reservation Form
Please Note: (*) indicates responses are required.
DATE & TIME
*Date: (mm/dd/yyyy)

 
In the case of a large group requiring two separate visits, please indicate the second date here:
Second Date: (mm/dd/yyyy)

 
IMPORTANT:I have checked the calendar for available dates
You must check this box:
*
About Your Group
School or Organization*:
District or Agency:
Address*:
City*:
Zip*:
Phone*:
FAX:
Email (principal/secretary)*:
Lead Person Name*:
Lead Person Email*:
Lead Person Phone Number:
Emergency Contact Name*:
Emergency Contact Phone*:
Grade Level(s) Attending*:
Number of Students Attending*:
Number of Adults*:
Number of Cars Requesting "Visitor" Parking Passes:
Lunch
Special Considerations for Your Group
Please describe:
Planetarium Presentation Requested
With special topics if needed:
Science Center Activity Requested
Please tell us which of the activities listed on our web site you want for your group: