Wagner Free Institute of Science: Summer 2020 Registration Form
Please fill out the information below with as much information as you have available. If you would prefer to have information sent to you via the post, please indicate so in the comments section. Email reservations( at) wagnerfreeinstitute (dot) org with any questions.
Contact Name
*
Prefix
First Name
Last Name
E-mail
*
Cell Phone Number
*
-
Area Code
Phone Number
Organization (if applicable)
Zipcode
*
Number of Students (Max. 20)
*
Number of Adults (for Citizen Science in the Yard)
*
Planned Date (Tuesday-Friday, mm/dd)
*
Planned Time (10-11, 11:30-12:30, 1-2, 2-3)
*
Age Range
*
Lesson Topic
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Please Select
Animal Adaptations (Tuesday)
Rocks & Minerals (Wednesday)
Urban Ecology (Thursday)
Dinosaurs & Fossils (Friday morning)
Fridays in the Field (Friday afternoon)
Additional Comments
Please provide details if any group members have special needs or require special assistance so that we can be prepared for your visit or any other concerns/questions.
*
I have read and agree to the
Terms and Conditions on the Policies Page.
Submit Form
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