Science on the Road Booking Request

School Name: *

Address: *

City/Town: *

Postal Code:

Telephone:

Email Address: *

Registration Contact: *

School Principal:

Requested Workshop(s):

Elementary School Demonstration Primary - We Like to Move It!
Grade 1 - Straws, Sticks, and Bricks
Grade 2 - H2Woah!
Grade 3 - May the Forces Be With You
Grade 4 - Facts of Light
Grade 5 - Slimy Science
Grade 6 - Electric Odyssey
Grade 7 - Beneath the Surface - Rocks and Minerals
Grade 8 - Beneath the Surface - Oceans
Above and Beyond Planetarium

Language: *
select...EnglishFrench

School Start: *
hour123456789101112 minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm

Recess Start:
hour123456789101112 minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm

Recess End:
hour123456789101112 minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm

Lunch Start: *
hour123456789101112 minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm

Lunch End: *
hour123456789101112 minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm

School End: *
hour123456789101112 minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm

Please choose three suitable dates for your school: *

Comments or Questions: