Your Group School/Group Name * School District * Address Address 1 * Address 2 City * State * - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming--Armed Forces (Americas)Armed Forces (Europe, Canada, Middle East, Africa)Armed Forces (Pacific)American SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoVirgin Islands ZIP code * County Email * Coordinator First Name * Coordinator Last Name * Coordinator Title/Role * Teacher Administrator Parent Librarian Other School Phone * Cell/Evening Phone * Other Phone First Preferred Date * “Mon-Fri” * Date * E.g., 09/18/2024 Second Preferred Date * “Mon-Fri” * Date * E.g., 09/18/2024 Third Preferred Date * “Mon-Fri” * Date * E.g., 09/18/2024 How Did You Hear About the Institute's Group Programs? * - Select a value -Educator GuideWebsiteReturning GuestWord of MouthPostcardEmailBillboardOther Virtual Program Details Program Choice(s) * Approaches to Problem Solving 3-5 Every Rock Has a Story 6-9+ Money! 3-5 Webs, Wings & Crawling Things PreK-2 What format will you use for the program? * (Zoom, Webex, Teams, Meet, etc) Links should be emailed to CISReservations@Cranbrook.edu at least 1 week prior to the program date. Student Location for Virtual Program * In-school (all students will be in a single classroom for this program) Remote (each student will be connecting from home to this program) Hybrid (some students will be connecting from home, others will be in a classroom) Anything else you'd like us to know? Please detail below. Any specific requests you'd like to make? Please detail below. Any special needs we should be aware of so we can accommodate? * Classroom #1 Information Class #1 Teacher Name * Class #1 Teacher Email * Preferred Class#1 Program Start Time * Class #1 Grade * Class #1 Number of Students * Classroom #2 Information Class #2 Teacher Name Class #2 Teacher Email Preferred Class #2 Program Start Time Class #2 Grade Class #2 Number of Students Classroom #3 Information Class #3 Teacher Name Class #3 Teacher Email Preferred Class #3 Program Start Time Class #3 Grade Class #3 Number of Students Classroom #4 Information Class #4 Teacher Name Class #4 Teacher Email Preferred Class #4 Program Start Time Class #4 Grade Class #4 Number of Students Classroom #5 Information Class #5 Teacher Name Class #5 Teacher Email Preferred Class #5 Program Start Time Class #5 Grade Class #5 Number of Students Deposit & Agreements Deposit * $100 You are paying a $100 registration fee to make a temporary reservation with Cranbrook Institute of Science. To secure your reservation, your remaining balance is due 45 days prior to your program(s). The registration fee will count towards the final balance. Confirmation * - Select a value -I understand and agree You are responsible for paying your remaining balance to the Institute’s Reservations Office no less than 45 calendar days prior to the day of your visit. No refunds or credits will be given the day of the visit. Confirmation * - Select a value -I understand and agree Cancellations made more than 45 calendar days before the date of visit can be rescheduled with no additional fees. Your $100 registration fee will be credited towards a future visit occurring before May 30, 2025, or forfeited should rescheduling not be feasible. Confirmation * - Select a value -I understand and agree Cancellations in writing made less than 45 calendar days before the date of visit forfeit registration fees and payments. Confirmation * - Select a value -I understand and agree Memberships and Free Passes are not applicable to Science on the Screen events. Confirmation * - Select a value -I understand and agree An Employee of the District/School is required to be present in the room with the class for the duration of the program. Confirmation * - Select a value -I understand and agree Leave this field blank Proceed to Checkout
