Summer Camp Group Visit 2018Reservation Request Form

Submit this form via email to group_reservations@brooklynkids.org, or fax to 718-604-7442. A reservationist will reply with a confirmation within 7 business days. Additional rescheduling will incur a charge of $10 per request.

INSTITUTION AND CONTACT INFORMATION Name of Camp: ______________________________ Contact Name: ________________________________ Address: ______________________________ Contact Cell Number: ___________________________ City & Zip Code: _________________________ Contact Email Address: _________________________ Phone Number: _________________________ School/Camp District Number: Title 1 School: □ Yes □ No

RESERVATION INFORMATIONPREFERRED DATE OF VISIT: Reservations must be made at least one month prior to your visit.

1st choice ___/___/_____ 2nd choice ___/___/_____ 3rd choice ___/___/_____ □ Multiple Visits over Several Dates

□ Guided Programs with Self-Guided Exploration

Select from a range of Educator-led inquiry-based programs: □ Amazing Engineers □ Brooklyn Builders □ Color-Lab Art Studio □ Insect Investigators □ Jam to the Music

See attached program descriptions for more information.

$300General Class up to 25 students

Tuesday - Friday□ 10:15 am – 11:00 am□ 11:15 am – 12:00 pm□ 12:15 pm – 1:00 pm

□ Self-Guided Exploration

Journey through BCM’s galleries and explore the diversity of our collections. $7 per camper

Tuesday - Friday□ 10:00 am – 1:00 pm□ 1:00 pm – 4:00 pm

□ Extended Exploration $10 per camper Tuesday - Friday

□ 10:00 am – 4:00 pm

CLASS INFORMATION: Maximum size is 25 students for general education groups, and 12 students for special needs groups . BCM requires a ratio of 5 students to 1 adult, with complimentary admission to those adults. Groups will be charged $7 for every missing or additional chaperone and campers. All paraprofessionals will receive complimentary admission with their special needs classes.

Camp Leaders or Teacher’s Name

Camp Leaders or Teacher’s Email

Name of Guided Program with Self-Guided Exploration

Grade Level

Special Needs

# Campers

# Chaperones

□ Yes □ No□ Yes □ No□ Yes □ No□ Yes □ No□ Yes □ No□ Yes □ No

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LUNCHROOM ACCOMMODATIONS: $1 per student.All groups requesting lunchroom accommodations must select a reservation time in order to eat in the Café or Rooftop. Groups that do not have a reserved lunch time are welcome to eat outdoors in nearby Brower Park. If there is inclement weather, BCM cannot guarantee space for groups without reservations.Do you need to reserve space to eat lunch? □ Yes □ No Will your group be purchasing lunch from our café? □ Yes □ No

Preferred Lunch Time: □ 10:20am – 10:50am □ 11:00am – 11:30am □ 11:45am – 12:15pm □ 12:30pm – 1:00pm

PAYMENT INFORMATION: A 50% non-refundable fee or the full program cost is due when making your reservation. The program balance can be paid with cash, check (payable to Brooklyn Children’s Museum), credit card, or NYC Department of Education purchase order(PO # must be present at check-in). Cancellations require 48 hours’ notice and deposits are non-refundable.

Pay via Credit Card:Credit Card Number Card TypeName on Credit Card Expiration Date / / Security Code

Billing Street Address: __________________________ Financial Contact Name: _____________________________Billing City: ___________________________________ Financial Contact Phone Number: ______________________Billing State: __________ Billing ZIP: __________ Financial Contact Email Address: ________________________

ACCESS PROGRAM QUESTIONNAIRE: For Groups with Special NeedsWe are committed to delivering programs that help all young people enhance and celebrate their abilities. We would like to know more about your group to make your program engaging and exciting for your campers.

My class is best described as: o An inclusive class with some individuals with disabilitieso A class made up of individuals with physical disabilitieso A class made up of individuals with learning disabilities o A class made up of individuals with both learning and

physical disabilities o Other: _______________________________________

What are your goals for your campers’ museum experience? (Utilize the space below for additional goals)o Build on or introduce a curricular themeo Engage in hands-on learningo Participate in interpersonal interactionso Take part in an educational experience outside the classroom

Which interactive learning styles work best for your campers?o Visual: pictures, charts, graphso Tactile: hands-on learning, making things, drawingo Kinesthetic: movement, acting out, physical activitieso Musical: rhythm, rhyme, music, environmental sounds o Linguistic: reading, playing word games, making up poetry or

stories o Logical: explore patterns and relationships, experimentation,

problem solving

Describe your classroom communication techniques. o Campers use non-verbal communicationo Campers use verbal communicationo Groups use both non-verbal and verbal communication

Are there physical, audio, visual or other adaptations the campers may need?_______________________________________________Specific Tools Your Class Utilizes for Communication: _______________________________________________

PROGRAM GOALS: Please describe the goals for your campers’ museum experience.

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