Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Birthday Date *

MM

DD

YYYY

Check if applicable *

I'm authorized to leave the premises for lunch

I'm authorized to leave with the Museum staff for field trips or assist with Outreach Programs

Parent or Guardian's Name *

First Name

Last Name

Parent's Phone *

(###)

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