Night at the Museum: December 2023 (student registration)

Student's full name: *

Student's grade (as of December 2023): * 3 4 5 6 if 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 full name: *

Email: *

Phone: *

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

Does your family qualify for the Free and Reduced School Lunch program?: Yes No

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: * animals art engineering nature physics

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

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

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 grant purposes only, how many members are in your household?:

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

What is your zipcode?: *

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.