Detroit Science Center

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ONLINE PRE-REGISTRATION FORM

If you prefer not to submit information online, you may print this form and fax/mail it to:

Field Trips
The New Detroit Science Center
5020 John R Street
Detroit, MI 48202
Fax: 313-832-1623

Please provide as much of the following information as possible.
*Denotes required fields.

*First Name:
*Last Name:
*School name:
Address:
City:
State:
Zip/Postal Code:
*Daytime Phone:
Evening Phone:
Fax:
E-mail:
Arrival Date (please select three dates):	1. 2. 3.
Estimated Arrival Time:
Estimated Departure Time:
Number of students:
Grade level:
Number of chaperones: (one chaperone for every 10 students)
Number of additional adults:
School district:
Check one:	Bring Lunch Order Lunch
Special needs: What packages are you interested in? Create Your Own Adventure Includes our four exhibit laboratories and your choice of two: Traveling Exhibit DTE Energy Sparks Theater (show) DaimlerChrysler Science Stage (show) Wind Mover (program) Create Your Own Adventure Plus Includes all Create Your Own Adventure options and your choice of one: IMAX^® Dome Theatre (film) Dassault Systèmes Planetarium (show) Ford Learning Resource Center (classroom program) Amazing Adventure Package Includes all Create Your Own Adventure options, a Ford Learning Resource Center classroom program and your choice of one: IMAX^® Dome Theatre (film) Dassault Systèmes Planetarium (show) Dynamic Domes Package Includes all Create Your Own Adventure options, an IMAX^® Dome Theatre film and a Dassault Syst�mes Planetarium show: IMAX^® Dome Theatre (film) Dassault Systèmes Planetarium (show) Tiny Tots Includes an SBC Children�s Gallery program and your choice of the following Dassault Syst�mes Planetarium shows: Zubenelgenubi�s Magical Sky Little Star Click below to submit field trip pre-registration