Please complete the form below and submit your request to SciWorks.
The SciWorks program coordinator will contact you to confirm your request.
Reservations are not confirmed until you receive a confirmation email from SciWorks. __________________________________________________________________________________________________
CONTACT INFORMATION
Date:     Group/School Name:
Email (required)
Street Address:
City:  
County: State:  Zip:
School Phone: ( )  Other Phone: ( )
Leader/Teacher Name:
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ADMISSION
Number of Students:    Number of Chaperones:     Grade:
Visit Date Requested: 1st Choice  2nd 3rd
Arrival Time:     Estimated Departure Time:  __________________________________________________________________________________________________
TYPE OF GROUP
Winston-Salem/Forsyth County School Group
Free student admission, 1 chaperone per 10 students is addmitted free
($5 per adult charge thereafter), Bus Drivers admitted free
Additional charges per person/per program apply. (see program prices below)

Other K-12 School Group
$5.00 per student admission, 1 chaperone per 10 students is addmitted free
($5 per person charge thereafter), Bus Drivers admitted free
Additional charges per person/per program apply. (see program prices below)

Pre-School Group
$3.00 per student admission,1 adult free with each child ($4 per person charge thereafter), Bus Drivers admitted free
Additional charges per person/per program apply. (see program prices below)

Public Group
Ages 2 and under are free; $4.00/per child Ages 3-5; $6.00 per person Ages 6-19 and Seniors;
1 chaperone per 10 students is addmitted free ($8 charge per person thereafter)
Bus Drivers admitted free
Additional charges per person/per program apply. (see program prices below)
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PROGRAMS
Program Cost: $5 per person
Laser Light Demos: $1 per person - available ONLY with purchase of Program
Program(s) Requested:                                             # of Students:      Grade:
    YOUNG SCIENTISTS (K-4): ---------------------------------- Down to Earth! (K-4) Barynard Basics (Outside) (PreK- Science Counts (K-2) Construction Zone (PreK-2) All About Animals (PreK-2) What’s The Buzz (PreK-2) Sounds All Around (PreK-2) Pop. Bubble, Fizz (PreK-2) Dinomite Dinos (PreK-2) Magnificient Magnets (K-2) Melting Pot (K-2) Weather Wonders (K-2) Terrific Teeth (K-2)    
    SCIENCE ADVENTURE (Grade 3-9): --------------------------------- Environmental Park Tours (3-9+) Science of Sound (K-3) Fur, Feather, Scale and Slime (2-6) Science Extravaganza (3-9) Light Fantastic (4-9+) Space Quest (3-9+) Science of Electricity (3-9+) Magical Mixtures (3-9+) The Endangered Zone (3-9+)     
    PLANETARIUM PROGRAMS: --------------------------------- In My Backyard (PreK-3) Sol & Company (PreK-3) Secret of the Cardboard Rocket (K-4) The Alien Who Stole Christmas (All Ages) Follow The Drinking Gourd (All Ages) Tis The Season (All Ages) Case of the Dispappearing Dinos (1-8) Mystery of the Missing Seasons (3-6) Planet Patrol (3-6) The Hunt for the Red Sprite (3-9+) Ring World (5+) Carolina Skies (4-9+) WSKY, Radio Station of the Stars (4-9+) The Mars Show (5-9+) The Explorers (5-9+) Lords of the Night (5-9+) Explorers of Mauna Kea (6-9) Invisible Universe (6-9+) Islands In A Sea of Night (9+)    
    LASER LIGHT DEMOS*: --------------------------------- Monsters and Mermaids Stars & Stripes Medley Space and Beyond Back Street Boys & N'SYNC Holiday Medley     
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