SUMMER SCIENCE REGISTRATION

Fill out form below and return with payment to:
 

Great Valley Museum, 1100 Stoddard Ave,. Modesto, CA 95350 

FAX to 549-7039. Call at 575-6196 if questions.

Name:_______________________________________  Child’s Age:_____      Grade in June 2008_____

Parent/Guardian’s Name:________________________ Are you a GVM member? ______

Address:______________________________________  Home Phone:__________________

City/State:_______________________________ Zip:___________  Work Phone:_________________

YOUNG CHILDREN CLASSES  FEE:  $25/program for Museum members; $32/program for non-members.

 3-day series 10-11 AM

     Kids Carpentry  Tues.-Thursday, June 17-19    

    Turtles are Amazing  Tues.-Thursday, June 24-26  

    Extraordinary Eggs  Tues.-Thursday, July 8-10    

    Canines & Felines    Tues.-Thursday, July 15-17    

    Stories of the Stars    Tues.-Thursday, July 22-24     

    Creepy Crawlies  Tues.-Thursday, July 29-31   

ELEMENTARY CHILDREN CLASSES    FEE:  $50/Museum members; $58/non-members.  
3-day Series 10 AM -Noon

     Predators of the Sea   Tues.-Thursday, June 24-26    

    Treasure Hunt/Scientists   Tues.-Thursday, July 8-10   

    Meet Me At the River  Tues.-Thursday, July 15-17   

    Measure Me    Tues.-Thursday, July 22-24    

    Weaving Words With Art  Tues.-Thursday, July 29-31    

TEENAGE CLASSES  FEE:  $50/program for Museum members; $58/program for non-members. 
3-day series 10 AM -noon.

_  Forensic Science 101    Tues.-Thursday, July 24-26 

_  Animal Stewards  Tues.-Thursday, July 8-10    

    Dissectathon    Tues.-Thursday, July 15-17    

TOTAL FEE ____________  Check Enclosed _________    

Credit Card No. ___________________________________   Exp. Date  ________  Signature __________________

 In case of emergency call (name):  ______________________________   (phone number): ____________

RELEASE AND HOLD HARMLESS AGREEMENT:  On behalf of myself and/or my minor child, I agree to release, indemnify, and hold harmless, the GREAT VALLEY MUSEUM OF NATURAL HISTORY, INC.,  (GVM) from any and all liability and claims, rights, demands, actions, causes of action, costs and expenses relating to loss injury or death to person or damage to property, and other relief sought (including, without limitation, costs, expenses, and actual attorney fees) of every kind, nature, or description, whether in tort, statute, or otherwise, arising directly or indirectly out of the participation of the undersigned in the activities caused in whole or in part by GVM, or any person or persons directly or indirectly employed by or anyone for whose acts GVM may be liable, irrespective or whether the claimed liability is caused by the active or passive negligence of GVM, save and except claims or litigation arising through the intentional or sole willful misconduct of GREAT VALLEY MUSEUM OF NATURAL HISTORY.

SIGNATURE:  ___________________________________________  DATE:  _________________