Virtual Group Program Request Form

Fields that contain a red * are required.

Notice to Children and Guardians

If you are under age 13 and you wish to participate in certain events or exhibits at, conducted by, or sponsored by the North Carolina Museum of Natural Sciences, your parent or guardian must register you and provide their consent as well as your information. Please ask your parent or guardian to fill out your online registration form or any other forms requesting your information.

Please see our privacy policy for additional information:

https://naturalsciences.org/about/privacy-policy

Name of Group Leader*

Email Address*

Phone Number*

School/Organization Name*

School/Organization Type*

Select

Check box if the school is Title 1

If Other

School/Organization Address*

City*

State*

Select

Country

County*

North Carolina County

Select

Zip Code*

Grade Level(s) of Students*

Please choose all that apply

Select

Number of Programs Needed*

Please be sure to check the minimum/maximum student requirements for the program you are requesting.

Number of Students Per Program*

If number of students varies, please select the highest.

Select or enter value

What is the Total Number of Students in your Group?*

(Should be equal or slightly less than the number of programs needed times the number of students per program)

How will your group be viewing the program?*

Select or enter value

Accommodations*

Select or enter value

If Other, Please Explain

Program Choice*

Select

1st Date Choice*

Please select a date that is at least 4 weeks out

2nd Date Choice*

Please select a date that is at least 4 weeks out

3rd Date Choice*

Please select a date that is at least 4 weeks out

Time Slot Choices*

Select all that apply

Select

After Hours Times

Please add requested times outside of our normal program time slots

Which Video Conferencing Tool(s) can you use?*

Select

If you selected other, please list.

Additional Information

Send me a copy of my responses

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