Download PASSPORT Request Form - Pink Palace Family Of Museums

PASSPORT Request Form
INSTRUCTIONS:
1. Complete PASSPORT Request Form and e-mail it to [email protected].
2. Pink Palace Staff will confirm your reservation by e-mail and attach an invoice.
School Name: ___________________________________________
Teacher Name: __________________________________________
Teacher E-Mail: _________________
Grade Level: _________
Number of Students: _______
Teacher School Phone Number: _____________ Ext. __________
Teacher Cell (or other Phone): _____________________________
By submitting this request, I agree to provide more than one week’s notice of cancellation of my reservation.
Canceling a reservation less than one week prior to the reservation date may result in a $5 penalty.
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PASSPORT Topic(s) Requested: Enter topic(s) from this list of topics into the Request Form below.
Giant Animal Cell Model
Giant Plant Cell Model
Animal and Plant Cell Models (classroom set of 4 animal and 4 plant cell models)
Animal Cell Mitosis Models (set of 9 models)
Compound Light Microscope with a set of prepared slides. Select from Animal & Plant Cell
Structure (5 slides) OR Animal & Plant Cell Mitosis (2 slides) OR Household Curiosities (8 slides).
Ten Microslide Viewers with a set of 10 Slide Strips. Select from Cell Structure OR Plant Mitosis OR
Cells of Your Body.
Extreme Cold Weather Gear
 Leaves
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Learning Labels (Nutrition)
Weddell Seals
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Insects
Sharks
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Fit Kids
Weather Instruments
Tree Cookies
Reservation Period
Aug 8-19, 2016
Aug 15-26, 2016
Aug 29-Sept 9, 2016
Sept 5-16, 2016
Sept 19-30, 2016
Sept 26-Oct 7, 2016
Oct 17-28, 2016
Oct 24-Nov 4, 2016
Nov 7-18, 2016
Nov 14-22, 2016
Nov 28-Dec 9, 2016
Dec 5-16, 2016, 2016
Jan 2-13, 2017
Jan 9-20, 2017
Jan 23-Feb 3, 2017
Jan 30-Feb 10, 2017
Feb 13-24, 2017
Feb 20-March 10, 2017
March 20-31, 2017
March 27-April 7, 2017
April 10-21, 2017
April 17-28, 2017
May 1-12, 2017
May 8-19, 2017
PASSPORT Topic
Fee