Pod Leaders: Night at the Museum – April 2025

Student's first name: *

Student's last name: *

Student's grade (as of April 2025): * 3 4 5 6 If your child is not in this grade range please check out our other awesome programs! (For safety and security of all involved there will be no exceptions to the grade range for this overnight program.)

Student's date of birth: *

Parent/Guardian's first name: *

Parent/Guardian's last name: *

Email: *

Phone: *

Does participant have any allergies? (if yes, please list): *

Please indicate the student's ethnicity (optional): American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White/Caucasian Other (specify below)

Other (specify):

STEAM interests: 1st choice: * art engineering nature physics space

STEAM interests: 2nd choice: * art engineering nature physics space

STEAM interests: 3rd choice: * art engineering nature physics space

Please list any family and/or friends that you would like to be in the same Pod with. (We will try to accommodate any requests, but it is not guaranteed):

If needed, please list any siblings that you would like placed in separate Pods:

For scholarship purposes only, how many members are in your household?: *

For scholarship purposes only, what is your household's yearly income?: *

What is your zipcode?: *

How did you hear about this program?: * Museum Newsletter Google Social Media Community Calendar Friend Other

Terms and Conditions (See link below): * I agree and understand that if I cancel within 2 weeks of the event no refunds will be issued and that the registration is non-transferable without prior authorization from museum staff.