School or Organization Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Lead Teacher/Primary Contact Name: *

First Name

Last Name

Lead Teacher or Contact Person Daytime Phone Number *

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1st Classroom Teacher: *

First Name

Last Name

1st Classroom Live Session Requested Date:

Refer to the Live Session Calendar on the Field Trip home page for availability. Tuesdays -Fridays only. You may decline a live session below if you do not wish to have a live session with your class. Discounts or refunds will NOT be provided for declined live sessions. The total cost of the field trip remains the same with or without a live session.

MM

DD

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2nd Classroom Teacher :

First Name

Last Name

2nd Classroom Live Session Requested Date:

Refer to the Live Session Calendar on the Field Trip home page for availability. Tuesdays -Fridays only.

MM

DD

YYYY

3rd Classroom Teacher:

First Name

Last Name

3rd Classroom Live Session Requested Date:

Refer to the Live Session Calendar on the Field Trip home page for availability. Tuesdays -Fridays only.

MM

DD

YYYY

4th Classroom Teacher:

First Name

Last Name

4th Classroom Live Session Requested Date:

Refer to the Live Session Calendar on the Field Trip home page for availability. Tuesdays -Fridays only.

MM

DD

YYYY

5th Classroom Teacher:

First Name

Last Name

5th Classroom Live Session Requested Date:

Refer to the Live Session Calendar on the Field Trip home page for availability. Tuesdays -Fridays only.

MM

DD

YYYY

6th Classroom Teacher:

First Name

Last Name

6th Classroom Live Session Requested Date:

Refer to the Live Session Calendar on the Field Trip home page for availability. Tuesdays -Fridays only.

MM

DD

YYYY

How will you be paying for the Virtual Field Trip? *

Visa or MasterCard over the Phone (see below to schedule)

Mailing a Check or Money Order

If you are paying via Visa or Mastercard over the phone, we will schedule a time to call you. Please choose a THURSDAY between the hours of 11 am and 3 pm for us to call you.

Please do not call the Museum. We will call you on the Thursday of your choosing, We will not be accepting payments on major Holidays.

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DD

YYYY

Widespread sharing of paid field trip links, labs, documents, and packets is prohibited as field trips are a paid service per classroom. If it is apparent that field trip links, labs, documents, and packets have been widely shared (through emails, social media, etc...), a fee of the original invoice will be charged for each time the links, labs, documents, and packets are shared. Payment from field trips are an important income to the museum's ongoing mission to provide educational services to our community. *

I, as the lead teacher/primary contact, and on behalf of all the additional teachers, understand that widespread sharing of Virtual Field Trip content is prohibited. Included but not limited to, posting on social media platforms and forwarding to others who have not paid for the materials. I understand that our school/organization will be charged a fee of the original invoice for each time content is shared with those outside of my current 2020-2021 classroom.

Payment is due two weeks prior to your requested live session date. The due date is stated on the invoice. You may mail in payment in the form of a check or money order, or call with a Visa or Mastercard on a pre-scheduled Thursday. You will not receive any virtual field trip content or services until the invoice is paid. *

I, as the led teacher/primary contact, and on behalf of all the additional teachers listed on this form, understand that I, nor additional classrooms (if applicable), will be provided with any virtual field trip content or live sessions until payment is received by the due date stated on the invoice.

The Western Science Center does not provide refunds under any circumstances. *

I, as the lead teacher/primary contact, and on behalf of all the additional teachers, understand that the Western Science Center does not provide refunds under any circumstances.

A $25.00 fee will be charged for each returned check. *

I, as the lead teacher/primary contact and on behalf of all the additional teachers, understand that a $25.00 fee will be charged for each returned check.

Virtual Field Trip video links, pdf's, live sessions, and optional labs will not be available until payment in full is received by the due date stated on the invoice. *

I, as the lead teacher/primary contact and on behalf of all the additional teachers understand that no Virtual Field trip video links, pdf's live sessions and optional labs will not be available until payment is received in full by the due date stated on the invoice.

The Western Science Center reserves the right to cancel Virtual Field Trip Requests and reserves the right to reschedule or cancel live sessions at any time, for any reason. *

I, as the lead teacher, primary contact and on behalf of all the additional teachers, understand that WSC reserves the right to cancel and/or reschedule Virtual Field Trip requests and live sessions at any time, for any reason.

I, and on behalf of the other teachers participating in the virtual field trip, hereby release, waive, discharge and covenant not to sue the Western Science Community Foundation dba Western Science Center and its affiliates, employees, volunteers, officers, trustees and directors, from any and all liability, claims, demands, actions and causes of action whatsoever, including attorney’s fees, arising out of or in any manner related to my participation in the Virtual Field Trip, Including any loss, accident, damage, injury that may be sustained whether caused by the negligence or disobedience. I understand that participation is completely my choice, and I choose to participate for my own personal benefit. *

I understand that participation is completely my choice, and I choose to participate for my own personal benefit.

I, and on behalf of the other teachers participating in the virtual field trip, understand that if we choose to participate or not participate in the Live Session(s) with a Museum Staff Member, that the cost of the Virtual Field Trip will remain the same. No discounts or refunds are provided if we choose not to participate. *

I, as the lead teacher/primary contact and on behalf of all the additional teachers, understand that the cost of the Virtual Field Trip remains the same if choose to participate or not to participate in the Live Session(s) with a Museum Staff Member, and that no refunds or discounts are provided if we choose to not participate.

By submitting this Virtual Field Trip request, I fully understand that I, and on the additional teachers' behalf, fully understand and agree to the Virtual Field Trip Contract policies as stated above. *

By submitting this request, I fully agree to all terms, conditions and policies stated above on my behalf and the additional teachers' behalf.