Discovery Lab on Wheels Interest Form

Bring the Museum to your classroom or organization for fun hands on activities with the Fort Worth Museum of Science and History’s Discovery Lab on Wheels program.

School/Center Name:*

Contact Person*

Street Address*

City and State*

Zip Code*

Phone Number*

Email*

Grade Level/Age Range*

Number of Students Participating *

Number of Classes (Our programs are designed for up to 30 students at one time. We are able to do multiple classes for large groups of students) *

What Program(s) are you Interested in?*

1st Date Choice*

MonthDayYear

2nd Date Choice*

Date

3rd Date Choice*

MonthDayYear

Proposed Start Time (Programs cannot start prior to 8:30. Programs are offered between 8:30am-5:00pm)*

Hour Minutes

AM/PM Option

Special Instructions: Is there anything that we should know about your school or facility prior to arriving? (parking, loading area, main office location, etc.)*