Name:

Title:

Day Phone:

Grade Level:

School/Organization:

Address:

City:

ZIP:

Cell/Evening Phone:

Email Address:

Note: By submitting this request, you are agreeing to release photo rights and relieve the City of liability for personal injury, wrongful death or property damage except as may be caused by the active negligence of the City. The City of Roseville staff reserves the right to photograph facilities, activities and program participants for future use. All photos will remain the property of the City of Roseville.

1st through 3rd grades - Planet Protectors (allow 2 hours for total field trip. Group sizes above 60 require an additional 45 minutes)

# Students:

x $3.75 = $

4th through 6th grades (allow 2.5 hours for total field trip. Group sizes above 60 require an additional 45 minutes)

# Students:

x $4.25 = $

One-hour School and Group Tours

Area of interest:

# Participants:

x $3.00 = $

Brownie UKI Try-It Badge Program - 1.5 hour program to complete badge requirements (note: badges purchased separately from Girl Scouts)

# Brownies:

Grant Funding Request for Schools Located Within the Roseville City Limits -There are limited grant funds available for program and transportation underwriting for public and private schools located within the City limits of Roseville. If you wish to request grant funds, please check the box below. Funds are available on a first come first serve basis.

Preferred Dates - please check on-line calendar for available dates (click here). The Exploration Center is open 10 - 5, Tuesday - Saturday. Please plan your trip accordingly.

First Date:

Second Date:

Third Date:

Preferred Start Time (please arrive 15 minutes prior to your start time):

Name:

Email:

Name:

Email:

Name:

Email:

Next Steps:

1. Print off a copy of your completed reservation form and click the submit button.
2. You will be notified by email within three working days to confirm your reservation.
3. We will ask you to confirm by email that you wish to reserve the proposed date and time.
4. This year we will not require a 25% deposit, but we will ask you to review and accept our cancellation policy (see below).
5. You will receive a reminder email two weeks prior to you field trip date.
6. Full payment is required at the time of your arrival to the Center. We accept Visa, Master Card and Discover Card. Checks should be made payable to the ?City of Roseville?.

Cancellation Policy: