Home School Program Registration

Participant Information

Participant's Name *

First Name Last Name

Grade Level (Fall 2017) *

Age *

Are you members of the MESS Hall? *

Yes No

Science Discovery Workshop

Spark Lab

April 4 Field Trip

We will attend

Have you attended a program at the MESS Hall before? *

Yes No

Jan SDW

Feb SDW

Apr SDW

Jan Spark

Feb Spark

Apr Spark

May SDW

May Spark

April Field Trip

Member

Cost of programs

discount amount

Minus membership

In addition to the workshops, visits to the MESS Hall can enhance your child's science learning this year. Consider adding a membership today for a discount of ${discountAmount} off of the programs.

Members to the MESS Hall receive free admission for the year, along with discounts on camps and reciprocal free admission to hundreds of science and children's museums across the country. Membership for a family of 4 is $110 for the year, only ${minusMembership} more than the registration for these programs.

Would you like to add a membership today?

*

Yes, please add a membership today No, not today

Names for Membership

Please enter up to 4 family members in the same household (can include a grandparent, nanny, or other caregiver in membership). Please contact us to include additional members for $12 each.

Adult Family Member 1

First Name Last Name

Family Member 2

First Name Last Name

Grade Level (or Adult)

Family Member 3

First Name Last Name

Grade Level (or Adult)

Family Member 4

First Name Last Name

Grade Level (or Adult)

Please contact us if you would like to add additional family members to the membership for an additional $12 per person.

Membership

Coupon Code

Onsite

Total

Total Summer 2017 Cost

USD MESSHall2018HomeschoolPrograms

Parent/Guardian Information

Name *

First Name Last Name

Main Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

E-mail *

example@example.com

Informed Consent and Acknowledgement

In consideration of my child’s participation in programs provided by the Pensacola MESS Hall, I indemnify and hold Pensacola MESS Hall and its affiliates, employees and agents harmless from and against any and all liability for negligence or medical expenses resulting from my child’s participation in such programs or other activities. I further release Pensacola MESS Hall and its affiliates, employees and agents from any and all negligence or other claims resulting from my child’s participation. I further understand that Pensacola MESS Hall does not provide medical insurance coverage for my child and that any medical expenses incurred will be paid by either my own medical insurance or myself. I hereby grant permission for my child to participate in all activities.

I give permission for my child’s photo and/or likeness to be retained and used by Pensacola MESS Hall without any remuneration or compensation.

Cancellation Policy & Tuition Refund

If a cancellation occurs…	Amount Refunded
5 or more calendar days before a program is scheduled to start (includes the weekend)	100%
1 to 4 calendar days before a program is scheduled to start (includes the weekend)	50%
Due to a no-show on the day the program is scheduled to start or subsequent days	0%

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Due to space considerations, all of these programs, except Tinker Tots, are drop-off only. Tinker Tots must have an accompanying guardian. In addition, we must limit Tinker Tot tag-alongs to no more than one per family.

The general museum will be closed during the program times, so plan a visit with your family during our regular operating hours.

Home School Spring 2018 Program Registration