Catalog of Education Program Questions 2022 KM additions 8_18_22

Catalog of Education Program Questions_2022_KM_additions_8_18_22.xlsx

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Catalog of Education Program Questions 2022 KM additions 8_18_22

OMB: 3095-0074

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Overview

Catalog of Education Program Qu
Commercial Account
Sleepover Information Collectio


Sheet 1: Catalog of Education Program Qu

GENERAL ADMISSION TOUR (Kennedy and GWB)





Type of group:






Select: School





Church





Civic





Tour Group





Other _______________________



Has your group visited before?






Select: Yes No


Mailing Address: (City, State, Zip Code)






Fill in the blank




Daytime Phone Number:






Fill in the blank




Type of tickets requested:






Fill in the blank: Adult _____





Senior (62+) _____





Youth (13 - 17) _____





Children (5 - 12) _____





Child (5 - 12) _____





Infant _____





Military (Retired) _____





Military (Veteran) _____





Military (Active Duty) _____





(Insert Affilliated University Name) Student, Faculty, and Staff _____





College Student (Non-Insert Affilliated University Name) _____



Questions or comment:






Fill in the blank











EDUCATION TOUR / SITUATION ROOM EXPERIENCE / BUS SCHOLARSHIP REQUEST (Kennedy, Reagan and GWB)





Confirm number participants and chaperones:






Fill in the blank: Pre-K _____





Kindergarten _____





1st - 5th grade _____





6th - 8th grade _____





9th grade _____





10th grade _____





11th grade _____





12th grade _____





Undergraduate _____





Graduate _____





Educator _____





Chaperone _____





Parent _____





Adult _____





Participants _____



Date of visit? Select date:





What time will participants arrive for the Situation Room Experience? The Situation Room Experience is two and a half full hours. Please plan to spend at least THREE HOURS in the simulation.






Fill in the blank:




What time will participants arrive for the Situation Room Experience? The Situation Room Experience is three full hours (half-day). Please plan to spend at least FOUR HOURS in the simulation.






Fill in the blank:




What time will students arrive? Select time:












What time will participants arrive? Select time:












Self-guided Presidential Library Tour






Check the box




Docent-led Presidential Library Tour






Check the box





Select: Museum





Special Exhibit





Park



Guided-School Program






Check the box




Museum-Educator Program






Check the box




Transportation to museum:






Select: Bus





Car





Bus and Car



Will you need a bus scholarship?






Select: Yes No


We are happy to offer financial assistance. Will you be requesting funding?






Select: Yes No


Actual bus cost estimate:






Fill in the blank




Statement of financial need from the school principal:






Essay response




Teacher signature:






Sign and Date




Principal signature:






Sign and Date




Lunch plans:






Select: Bring Sack-Lunches





No Lunch





Pre-order Box Lunches





Cater-in



Executive lunch plans:






Select: No Lunch





Pre-order Box Lunches





Café & Pub





Buffet



On-site contact name: (first and last)






Fill in the blank




On-site contact cell:






Fill in the blank




On-site contact e-mail:






Fill in the blank




Independent home school:






Select: Yes No


Region:






Fill in the blank




School district:






Fill in the blank




Type of school:






Select: Charter





Private





Public





Other ___________________________



Organization name:






Fill in the blank




Organization address: (street number and name, city, state, and zip code)






Fill in the blank




Organization website:






Fill in the blank




Principal or head of organization name: (first and last)






Fill in the blank




Principal or head of organization direct number:






Fill in the blank




Principal or head of organization e-mail address:






Fill in the blank




Is there anything special we should know about your group?






Fill in the blank




Do you need meeting space?






Select: Yes No


Field trip confirmation number:






Fill in the blank




Agenda






Fill in the blank




Pre-packet sent






Check the box




Representative submitted signed policy and use agreement.






Check the box




RESEARCH PROGRAM QUESTIONS (NYC)





Date of visit:






Fill in the blank: 1st choice: __________________





2nd choice: __________________





3rd choice: __________________



Expected time of arrival?






Fill in the blank




Duration of visit:






Fill in the blank




Number of students:






Fill in the blank




Number of educators and chaperones:






Fill in the blank




Grade level:






Fill in the blank




Type of class: (history, research, civics, language arts, other)






Fill in the blank




Location of program:






Select: On-site





Off-site



Topic selection:






Select: Immigration





World War II





The Bill of Rights





Inventions





Desegregation





Genealogy





Civil Rights





The New Deal





Women's Rights





Copyright





Court Cases





Labor





Prohibition





Cold War





Great Depression





Maritime





Photographs





Civil War





The Constitution





Disaster at Sea





That's Entertainment





Other ________________________________



Teacher's name:






Fill in the blank




School name:






Fill in the blank




Street address:






Fill in the blank




City:






Fill in the blank




State:






Fill in the blank




Zip code:






Fill in the blank




E-mail:






Fill in the blank




School phone number:






Fill in the blank




Cell phone to reach you if needed the day of the visit:






Fill in the blank




Would you like to receive the Education Updates Blog from the National Archives?






Select: Yes No









TRAVELING TRUNK PROGRAM (Reagan and GWB)





Traveling Trunks may be rented for 2 week or 4 weeks by an educator, administrator, or school district:






Select: One week





Two Weeks





Four Weeks



Pick-up or ship:






Select: Pick-up





Ship



Payment method:






Select: Check





Credit Card



Payment information (name,credit card number, expiration date, security code, account number, routing number)






Fill in the blank




Billing address: (street number and name, city, state, and zip code)






Fill in the blank




Shipping address: (street number and name, city, state, and zip code)






Fill in the blank











EDUCATOR WORKSHOP QUESTIONS (Reagan)





Can you attend?






Select: Yes, I'll be there No, I cannot attend


Full name:






Fill in the blank




First name:






Fill in the blank




Last name:






Fill in the blank




E-mail address:






Fill in the blank




Phone number:






Fill in the blank




How many persons will attend?






Fill in the blank




What company or school are you associated with?






Fill in the blank




What is the name of the school or organization where you teach?






Fill in the blank




If you are an educator, what grade levels do you teach?






Fill in the blank




How did you hear about this event?






Fill in the blank











FILM THIS! QUESTIONS (Reagan) (ages 14 - 19)





Student Name






Fill in the blank




I am interested in attending:






Select: Session A





Session B



Paid or Scholarship






Select: Paid





Scholarship



Student email






Fill in the blank




Parent email






Fill in the blank




Parent Signature






Sign and Date




Student Signature






Sign and Date




Write one paragraph explaining why you would like to participate in the Reagan Student Media Seminar.






Essay response




Write one paragraph describing your experience with film and media.






Essay response




Describe your reasons for needing financial assistance.






Essay response




How much of the amount are you able to pay?






Essay response




Which session would you prefer?






Essay response











ONLINE / DISTANCE LEARNING QUESTIONS (Reagan)





What are the names of people attending webinar?






Fill in the blank




What is your school name and field trip date?






Fill in the blank




Which session date do you plan to attend?






Date is selected from a drop down menu of options.




What is your email address?






Fill in the blank











PROFESSIONAL DEVELOPMENT WEBINAR (LO including Archives 1, New York, College Park)





Teacher Name






Fill in the blank




Title






Fill in the blank




Phone Number






Fill in the blank




Education Institution/Organization Name






Fill in the blank




City






Fill in the blank




State






Fill in the blank




Select a Webinar






An Introduction to DocsTeach: Discover DocsTeach.org, the online tool for teaching with documents from the National Archives.





Teaching the Charters of Freedom: Join the National Archives for a hands-on session and discover resources for teaching the founding documents of the United States.





Fill in the blank from a menu of rotating webinars




Select a Time Zone (for by-request webinars only)






Alaska Standard Time





Atlantic Standard Time





Central Standard Time





Eastern Standard Time





Hawaiin-Aleutian Standard Time





Mountain Standard Time





Pacific Standard Time




Preferred Date 1 (for by-request webinars only)






Fill in the blank




Preferred Time 1






Fill in the blank




Preferred Date 2 (for by-request webinars only)






Fill in the blank




Preferred Time 2






Fill in the blank




Preferred Date 3 (for by-request webinars only)






Fill in the blank




Preferred Time 3






Fill in the blank




Number of Participants






Fill in the blank




Occupation






Fill in the blank




Grade Level






Fill in the blank




Special Accommodations






Select: Yes No



Space to write in any special accommodations.




Comment or Questions






Space to write in any comments or questions.




Connect with the National Archives





Would you like to receive emails about new teaching tools, lesson plans, online activities, field trips, professional development, and primary sources our Education Updates Blog?






Select: Yes No


Would you like to receive emails about upcoming education programs?






Select: Yes No









K-12 DISTANCE LEARNING PROGRAMS (LO including A1 and New York)





Teacher Name






Fill in the blank




Title






Fill in the blank




Phone Number






Fill in the blank




Email Address






Fill in the blank




School Name






Fill in the blank




Address 1






Fill in the blank




Address 2






Fill in the blank




City






Fill in the blank




State






Fill in the blank




Zip






Fill in the blank




Select an Elementary School Distance Learning Program






(K-2) Our Classroom Bill of Rights





(K-2) What Happens in Washington?





(3-5) The Charters of Freedom: Building a More Perfect Union





(3-5) Superhero Bill of Rights





(3-5) Rightfully Hers: American Women and the Vote





(4-5) The Constitution at Work: Elementary School Edition




Select a Middle School Distance Learning Program






(6-8) The Charters of Freedom: Building a More Perfect Union





(6-8) Decoding the Declaration





(6-8) The Constitution at Work: Middle School Edition





(6-8) The Bill of Rights in Real Life





(6-8) Rightfully Hers: American Women and the Vote




Select a High School Distance Learning Program






(9-12) The Charters of Freedom: Building a More Perfect Union





(9-12) Decoding the Declaration





(9-12) Know Your Rights





(9-12) Rightfully Hers: American Women and the Vote




Select a Time Zone






Alaska Standard Time





Atlantic Standard Time





Central Standard Time





Eastern Standard Time





Hawaiin-Aleutian Standard Time





Mountain Standard Time





Pacific Standard Time




Preferred Date 1






Fill in the blank




Preferred Time 1






Fill in the blank




Preferred Date 2






Fill in the blank




Preferred Time 2






Fill in the blank




Preferred Date 3






Fill in the blank




Preferred Time 3






Fill in the blank




Connection Preference





Select: I would like the Nation Archives to provide a web conferencing link for the program





I can provide a web conferencing link for the program





Unsure



Number of Participants






Fill in the blank




Number of Students






Fill in the blank




Grade Level






Select: K





1





2





3





4





5





6





7





8





9





10





11





12



Type of Class (U.S. History, Civics, Language Arts, etc.)






Fill in the blank











Special Accommadations






Select: Yes No



Space to write in any special accommadations.




Comment or Questions






Space to write in any comments or questions.




The National Archives requires that the requesting educator or another educator from your institution be present during the student distance learning program to observe the session and support classroom management. The National Archives cannot fulfill program requests for non-supervised sessions.





I confirm that I have read, understand, and agree to the above statement.






Select: Yes No









Would you like to receive emails about new teaching tools, lesson plans, online activities, field trips, professional development, and primary sources our Education Updates Blog?






Select: Yes No


Would you like to receive emails about upcoming education programs?






Select: Yes No









8/18/2022 Additional questions for Civics for All of US Student Program Registration




Number of Devices






Fill in the blank




I would like to receive emails from the National Archives Foundation






Select: Yes No


LEARNING LAB REGISTRATION (ARCHIVES 1)





Teacher's Name






Fill in the blank




Title






Fill in the blank




Email






Fill in the blank




Phone Number






Fill in the blank




Cell Phone Number (Required for Day of Visit)






Fill in the blank




School Name






Fill in the blank




Address 1






Fill in the blank




Address 2






Fill in the blank




City






Fill in the blank




State






Fill in the blank




Zip






Fill in the blank




Preferred Date 1






Fill in the blank




Select a Program Time and Time 1






Select: The Charters of Freedom: Building a More Perfect Union





The Constitution Lab: Explore how the actions of the Federal Government are based on the Constitution (Grades 6-12)



Preferred Date 2






Fill in the blank




Select a Program Time and Time 2






See options to select from under: Select a Program Time and Time 1




Preferred Date 3






Fill in the blank




Select a Program Time and Time 3






See options to select from under: Select a Program Time and Time 1




Number of Students






Fill in the blank




Number of Teachers And Other Chaperones (We ask that there be 1 chaperone for every 10 students)






Fill in the blank




Grade Level (Programs are available for grades K-12)






Select: 3





4





5





6





7





8





9





10





11





12



Type of Class (U.S. History, Civics, Language Arts, etc.)






Fill in the blank




Special Needs Accommodations






Select: Yes No



Space to write in any special accommadations.




Enter your comments or questions here






space to write in comments or questions




Would you like to receive emails about new teaching tools, lesson plans, online activities, field trips, professional development, and primary sources our Education Updates Blog?






Select: Yes No


Would you like to receive emails about upcoming education programs at the National Archives?






Select: Yes No









NATIONAL ARCHIVES PAJAMA PARTY (LO)





Parent/Guardian Last Name






Fill in the blank




Paren/Guardian First Name






Fill in the Blank




Preferred email address






Fill in the blank




Last name of the child you are registering






Fill in the blank




First name of the child you are registering






Fill in the blank




If you are registering additional children, please enter their names here.






Fill in the blank




City






Fill in the blank




State






Fill in the blank




Zip Code






Fill in the blank




Is this the first time your family has participated in a National Archives education program? *






Select: Yes No Not sure

How did you find out about this program? Please check all that apply.






Select: E-mail from the National Archives or the National Archives Foundation





National Archives Social Media (Facebook, Instagram, Twitter)





Other Social Media





Through a friend/family member





Other



Would you like to receive emails about upcoming National Archives education programs? *






Select: Yes No Not sure








GROUP TOUR AND FIELD TRIP RESERVATIONS (LBJ)






Group Type




Are you a:






Select: Pre-K-12 Group





College/University Group





General Group




[Pre-K-12] Tell Us About Your Visit






Name of School or Group






Fill in the blank




Name of Tour Company (if applicable)






Fill in the blank




Preferred Visit Date






Fill in the blank




Alternative Visit Date






Fill in the blank




If you are planning to visit over the course of multiple days, please indicate below. Number of Students (15 minimum, 60 maximum)






Fill in the blank




Grade Level(s)






Fill in the blank




Ages of Students






Fill in the blank




Number of School Staff. Please include bus driver(s) and/or coordinator.






Fill in the blank




Number of Other Adult Chaperones






Fill in the blank




How would you like to spend your time at the library? (?) Our immersive classroom experiences take place in the Lady Bird Education Center, located on the second floor of the LBJ Library. Each experience is hands-on giving students the opportunity to work with our primary resources from our archives or with artifacts from our museum collection.



Guided tour, no immersive classroom experience






Preferred Start Time






Select: 9:30 a.m.






11:30 a.m.






1:30 p.m.






2:30 p.m.




Alternative Start Time






Fill in the blank




Preferred Length of Tour (Min. time: 60 minutes, Typical tour is 90 minutes)






Fill in the blank



Guided tour with immersive classroom experience






Preferred Start Time






Select: 9:30 a.m.






11:30 a.m.






1:30 p.m.




Which immersive classroom experience would you like to participate in? A tour is included with each experience.Note(s): 1) The tour portion of your visit is self-guided. The classroom experience is facilitated and led by an LBJ Library Education Specialist. 2) Please visit our Education page to learn more about each of our experiences.





Dropdown: The Spy's Dilemma/LBJ and the Cold War Program and Tour (2.5-3 hours)






Vietnam: A Presidential Decision Program and Tour (3-4 hours) A






Civil Rights Investigation: Mississippi Burning Program and Tour (1-1.5 hours)






A Matter of Civil Rights Program and Tour (2 hours)






Great Society Program and Tour (2-3 hours) Election Collection Program and Tour (2-2.5 hours)






Election Collection Program and Tour (2-2.5 hours)



Self-guided tour, no immersive classroom experience






Preferred Start Time Please select a time between 9:30 a.m.-3:30 p.m.






Fill in the blank




Alternative Start Time






Fill in the blank




Preferred Length of Tour (Min. time: 60 minutes, Typical tour is 90 minutes)






Fill in the blank



Self-guided tour with immersive classroom experience






Preferred Start Time Please select a time between 9:30 a.m.-3:30 p.m.






Fill in the blank




Which immersive classroom experience would you like to participate in? A tour is included with each experience. Please visit our Education page to learn more about each of our experiences. Self-guided tour with immersive classroom experience





Dropdown: The Spy's Dilemma/LBJ and the Cold War Program and Tour (2.5-3 hours)






Vietnam: A Presidential Decision Program and Tour (3-4 hours) A






Civil Rights Investigation: Mississippi Burning Program and Tour (1-1.5 hours)






A Matter of Civil Rights Program and Tour (2 hours)






Great Society Program and Tour (2-3 hours) Election Collection Program and Tour (2-2.5 hours)






Election Collection Program and Tour (2-2.5 hours)

College/University Group






Name of School or Group






Fill in the blank




Name of Tour Company (if applicable)






Fill in the blank




Preferred Visit Date






Fill in the blank




Alternative Visit Date






Fill in the blank




If you are planning to visit over the course of multiple days, please indicate below.






Fill in the blank




Number of Students (60 maximum)






Fill in the blank




Number of faculty/staff and bus driver(s)






Fill in the blank




How would you like to spend your time at the library?






Immersive classroom experience only, no tour






Which immersive classroom experience would you like to participate in?Please visit our Education page to learn more about each of our experiences.






Dropdown: Vietnam: A Presidential Decision Program and Tour (3-4 hours) A






Civil Rights Investigation: Mississippi Burning Program and Tour (1-1.5 hours)






A Matter of Civil Rights Program and Tour (2 hours)






Great Society Program and Tour (2-3 hours) Election Collection Program and Tour (2-2.5 hours)






Introduction to Holdings and Tour (2 - 3 hours)



Guided tour, no immersive classroom experience






Preferred Tour Start Time






Select: 9:30 a.m.






11:30 a.m.






1:30 p.m.






2:30 p.m.




Alternative Start Time






Fill in the blank




Preferred Length of Tour (typical tour is 90 minutes)






Fill in the blank



Guided tour, with immersive classroom experience






Preferred Tour Start Time






Select: 9:30 a.m.






11:30 a.m.






1:30 p.m.




Which immersive classroom experience would you like to participate in?Please visit our Education page to learn more about each of our experiences.






Dropdown: Vietnam: A Presidential Decision Program and Tour (3-4 hours) A






Civil Rights Investigation: Mississippi Burning Program and Tour (1-1.5 hours)






A Matter of Civil Rights Program and Tour (2 hours)






Great Society Program and Tour (2-3 hours) Election Collection Program and Tour (2-2.5 hours)






Introduction to Holdings and Tour (2 - 3 hours)



Self-guided tour, no immersive classroom experience






Preferred Start Time Please select a time between 9:30 a.m.-3 p.m.






Fill in the blank




Alternative Start Time






Fill in the blank




Preferred Length of Tour (typical tour is 90 minutes)






Fill in the blank



Self-guided tour with immersive classroom experience






Preferred Start Time Please select a time between 9:30 a.m.-3 p.m.






Fill in the blank




Which immersive classroom experience would you like to participate in? A tour is included with each experience.Note(s): 1) The tour portion of your visit is self-guided. The classroom experience is facilitated and led by an LBJ Library Education Specialist. 2) Please visit our Education page to learn more about each of our experiences.





Dropdown: Vietnam: A Presidential Decision Program and Tour (3-4 hours) A






Civil Rights Investigation: Mississippi Burning Program and Tour (1-1.5 hours)






A Matter of Civil Rights Program and Tour (2 hours)






Great Society Program and Tour (2-3 hours) Election Collection Program and Tour (2-2.5 hours)






Introduction to Holdings and Tour (2 - 3 hours)

General Group or Contact Information






Name of Group






Fill in the blank




Name of Tour Company (if applicable)






Fill in the blank




Preferred Visit Date






Fill in the blank




Alternative Visit Date






Fill in the blank




If you are planning to visit over the course of multiple days, please indicate below.






Fill in the blank




Friendly reminder: We do not offer guided tours for non-school groups. For more information, please contact the Volunteer and Visitor Services Office at (512) 721-0184.





What is your preferred start time?Self-guided tours are available between 9:30 a.m.-3:30 p.m.






Fill in the blank



Alternative Start Time We ask for an alternative arrival time in case many self-guided tours are booked on the day of your visit. We want to ensure your group is accommodated and that your visit is pleasant.









Fill in the blank




Preferred Length of Tour (Min. time: 60 minutes, Typical tour is 90 minutes)






Fill in the blank



Tell us about your group.





This will help us efficiently check you in on your day of visit.






Number of Tour Director(s) or Group Leader(s) and Bus Driver(s) (Free admission)






Fill in the blank




Number of Adults (Admission $7)






Fill in the blank




Number of Seniors (Admission $5)






Fill in the blank




Number of Youth (13-17) (Admission $3)






Fill in the blank




Number of Children (12 and under) (Free admission)






Fill in the blank




Number of Non-UT Austin College/University Students (Admission $3)






Fill in the blank




Number of UT Austin Students, Staff, and Faculty (Free admission)






Fill in the blank




Number of Active Duty Military (Free admission)






Fill in the blank




Number of Former Military (Admission $5)






Fill in the blank




Number of LBJ Library Members and Other NARA Presidential Library Members (Free admission)






Fill in the blank




Main Contact First Name






Fill in the blank




Main Contact Last Name






Fill in the blank




Main Contact Person Title:






Fill in the blank




Email Address






Fill in the blank




Phone Number (Direct line or cell phone preferred)






(XXX) XXX-XXXX




Street Address






Fill in the blank




Address Line 2






Fill in the blank




City






Fill in the blank




State






Drop down list of every U.S. state




Zip Code






Fill in the blank




On the day of your visit, will there be a different point of contact?






Select: Yes No


Day-of Contact First Name:






Fill in the blank




Day-of Contact Last Name: Day-of Contact Email Address






Fill in the blank




Day-of Contact Phone Number (Cell phone preferred)






Fill in the blank



Additional Information






Additional CommentsInclude any specific day-of needs, ADA accommodations, or more






Fill in the blank




If you have been in touch with a specific LBJ Library contact, please include their name below:






Fill in the blank




Would your group like to visit our museum store—The Store at LBJ?






Select: Yes No
LIBRARY QUESTIONS (Kennedy)





Have you ever visited the museum?






Fill in the blank




Have you brought students for a guided program? (Which one?)






Fill in the blank




How did you learn about this program?






Fill in the blank




Will you (briefly) indicate how the visit relates to your school curriculum?






Fill in the blank




Confirm number participants and chaperones:






Fill in the blank: Pre-K _____





K - 2nd _____





3rd - 5th grade _____





6th - 8th grade _____





9th grade _____





10th grade _____





11th grade _____





12th grade _____





Undergraduate _____





Graduate _____





Educator _____





Chaperone _____





Parent _____





Adult _____





Participants _____



We are happy to work with you to provide reasonable accommodations for students. Please let us know how we can support you.






Fill in the blank











4/8/2022 - Questions to be cleared for na-2026inst





Type of program






Onsite





Distance learning




Will you recommend this program to other educators (167)?






Yes





No





Why or why not?






Fill in the blank



What did you like best about the program? 






Fill in the blank




Did you share any of the pre- or post- program activities with your students?






Yes





No





If yes, which activities did you use?




Does this program meet any district-wide objectives?






Yes





No




 What types of civic education resources are you most interested in from the National Archives? (rank level of interest)






Distance learning programs






Extremely interested





Very interested





Somewhat interested





Not so interested





Not at all interested 




Onsite field trip programs at National Archives and Presidential Library sites






Extremely interested





Very interested





Somewhat interested





Not so interested





Not at all interested 




Lesson plans






Extremely interested





Very interested





Somewhat interested





Not so interested





Not at all interested 




Online teaching activities on DocsTeach.org






Extremely interested





Very interested





Somewhat interested





Not so interested





Not at all interested 




Videos






Extremely interested





Very interested





Somewhat interested





Not so interested





Not at all interested 




Online primary sources






Extremely interested





Very interested





Somewhat interested





Not so interested





Not at all interested 




Other (please specify)






Fill in the blank



Participating in this program has increased my confidence in teaching with primary






Strongly Agree





Agree





Disagree





Strongly Disagree




Participating in this program will help me improve students' civic knowledge and skills.






Strongly Agree





Agree





Disagree





Strongly Disagree





Sheet 2: Commercial Account

Commercial Account Request (Recreation.gov)
Organization name:

Fill in the blank
Organization address: (street number and name, city, state, and zip code)

Fill in the blank
Principal or head of organization name: (first and last)

Fill in the blank
Principal or head of organization direct number:

Fill in the blank
Principal or head of organization e-mail address:

Fill in the blank
Representative acknowledges receipt of museum visitor policy and accepts responsibility for their clients while onsite.

Check the box
Business License Number

Fill in the blank
Expiration Date

Fill in the blank

Sheet 3: Sleepover Information Collectio

Minor’s Name
Minor's Age
Name
Date
Parent or Legal Guardian Name Printed
Parent or Legal Gurdain Signature
Parent of Legal Guardian DOB
Address
Phone
Cell
City
State
Zip
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