Online Traveling Lab Form

Use this secure form to reserve an Energy IQ, Money Game or Pollution Detectives Traveling Lab using your credit card.

 

I want to reserve: Energy IQ Lab Money Game Pollution Detectives Lab

Rental Period From: To:

School:

Teacher:

School Address: School Zip:

School Phone: Home Phone: Other Phone:

Email:

School hours from am to pm

Number of classes participating:

Total number of students:

Memphis City Schools, Shelby County Schools & Other Schools located in Shelby County fill in this section only.

Please check one of these categories: Memphis City School Shelby County School Other School Located in Shelby County

I would like to keep the Lab for weeks.

Please read the following carefully and be sure you agree to all terms and conditions:

  • I will return the Lab on time with the completed assessment form to the museum.
  • I will pick up the Lab on: and return it on: .
  • If any Lab items are missing or damaged I will notify the museum's education staff immediately. I will return all items cleaned and in good condition.
  • I am responsible for missing or damaged items, and may be asked to replace them (depending on value).

All Other Schools located outside of Shelby County must fill in this section.

Other School

I would like to keep the Lab for weeks at $25 per week for a total cost of $ .

Credit Card: VISA MasterCard Discover

Name on Credit Card:

Credit Card Expiration Date (xx/xx): Credit Card Account Number:

Your credit card number will be hidden as you type it into the box. This is a password box allowing visitors to enter confidential information without other people viewing the information. The Children's Museum of Memphis makes every effort to protect your credit card information.

Please read the following carefully and be sure you agree to all terms and conditions:

  • I am authorizing my credit card above to be charged $ for weeks for the Lab.
  • I will pick up the Lab on: and return it on: .
  • If any Lab items are missing or damaged I will notify the museum's education staff immediately. I will return all items cleaned and in good condition.
  • I am responsible for missing or damaged items, and may be asked to replace them (depending on value).
  • I will return the Lab on time with the completed assessment form to the museum.

Comments, Questions or Suggestions:


By hitting the submit button below, you are authorizing The Children's Museum of Memphis to charge the credit card above with the amount of your indicated purchase.