Educational Outreach Request Form

Educational Outreach Request Form

Please allow 3-5 business days for a member of our team to confirm your booking. If you are making this request on behalf of a corporate or community organization, please fill out the Community Outreach Form here: https://form.jotform.com/253084421290148
Primary Contact*

First NameLast Name
Contact Number*
Please enter your personal contact number.Format: (000) 000-0000.
Email Address*
example@example.com
School Name*
School Phone Number*
Number of Participants*
Grade Level(s)*
Select all that apply
YesNo
Title-1 LEA ID
Campus Number
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Customize Your Health Museum Mobile Experience

Each class session is scheduled for 30-45 minutes. A singular session can accommodate up to 50 students. For larger groups, a second educator is required for a $100 flat fee. Prices listed below are base fees, additional charges may apply.

PLEASE DO NOT REFRESH THE PAGE!*

Discovery Carts

Discovery Cart

Select your topic of choice from our mobile education cart offerings.

$300.00 Discovery Cart

Live Dissection Demo (recommended for all ages)

Live Dissection Demo

Watch a live organ dissection with a Health Museum educator. Fee is per session (max capacity 50).

$250.00

Organ	Sessions
Sheep Heart
Cow Eye
Sheep Brain

DIY Dissections (recommended for Grades 5 & up)

DIY Dissections

45-60 minutes | 25 student minimum, up to 30 students per session

$15.00

Please choose an organ	Quantity	Price
DIY Owl Pellet: Pre-K - 4th Grade		$15.00
DIY Cow Eye: 5th Grade & Up		$15.00
DIY Sheep Heart: 6th Grade & Up		$15.00
DIY Sheep Brain: 6th Grade & Up		$15.00

Clinical Case Labs (recommended for Grades 5 & up)

Clinical Case Labs

45 minutes | Grades 5 & up | Fee is per session (max capacity 50).

$250.00

Please choose a lab	Sessions
Cardiovascular & Respiratory System
The Brain & The Science of Addiction

Skills Labs (recommended for Grades 5 & Up)

Skills Labs

45 minutes | Grades 5 & up | 25 student minimum

$15.00

Please choose a lab	Students
CPR Lab
Suturing Lab
Splints Lab

Health Adventures (recommended for Pre-K & Up)

Health Adventures

30 minutes | 30 student minimum | Limit of 2 classes per onsite experience

$10.00

Please choose up to 2 classes	Students	Price
Healthy Habits		$10.00
Squeaky Clean		$10.00
Busy Bodies		$10.00
Poop-Tastic Adventures		$12.00

Healing Arts (recommended for Grades 8 & Up)

Human Figure Drawing Lab

Exclusively available on Fridays | 45 minutes | Up to 20 students per session | Explore the human form through Leonardo DaVinci's eyes with artist-guided observational drawing.

$4.00 Students

Souvenir Bags

Souvenir Bags

Take home souvenirs from the Amazing Body Store! Each K-5 bag contains: Color Changing Pencil & Eraser, Brain Notepad, & Stretchy Skeleton Toy. Each 6-12 bag contains: Syringe Pen, Brain Notepad, & THM Stress Reliever

$5.00

Souvenir Bag	Quantity	Price
Souvenir Bag (K-5th)		$5.00
Souvenir Bag (6th-12th)		$7.00

Total

$0.00

What date and time would you like your THM Mobile Experience? Selecting a date does not guarantee museum staff availability. *
Any other specific date and time, if the above selection is not suitable.

MonthDayYear
Date
Hour MinutesAM/PM Option
SUBMITTING THIS INTAKE FORM DOES NOT GUARANTEE YOUR SELECTED DATE(S). YOUR RESERVATION IS NOT CONFIRMED UNTIL YOU ARE CONTACTED BY A MEMBER OF THE HEALTH MUSEUM'S OUTREACH TEAM AND HAVE PAID THE DEPOSIT. PLEASE ALLOW UP TO 5 BUSINESS DAYS TO PROCESS YOUR SUBMISSION. THE INVOICE ATTACHED TO YOUR SUBMISSION ONLY SERVES AS AN ESTIMATE.

Please Note: THM Mobile experiences with add-ons require advance reservation of at least 2 weeks. Without a processed deposit, add-on experiences may be cancelled. If full payment is not received within 10 business days of the scheduled experience, an educator cannot be guaranteed and any classes will be cancelled.

Travel fees will be included in your final invoice. A .70 cent per mile flat rate roundtrip from The Health Museum will be assessed for locations within a 15 mile radius of the museum. Any organization that is outside of the 15 mile radius will be charged an additional $25 travel fee.

To be considered a group, a reservation for at least 25 students must be made. If your group size changes to less than 25 students, your reservation will be cancelled.

Any groups that fail to cancel within 3 business days of their scheduled reservation will be billed the FULL reserved amount. Please see our website, www.thehealthmuseum.org, for further policy information.

If scheduling multiple reservations, a separate payment is required for each date reserved. If checks include more than one reservation payment, it will NOT be accepted. Please review the reservation for accuracy, and sign and return to us via e-mail within 5 business days. Please call 713-942-7635 or e-mail tsylvester@thehealthmuseum.org if you have any questions.
YesNo
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Educational Outreach Request Form

Customize Your Health Museum Mobile Experience