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Please use this form to register for our
September 21st, 2017 events.
Please call us at 716-434-3196 if you have any questions. Thank you!
Pre-registration is requested.
Fee payable at the door via cash or check.
Paypal button under repair, we apologize for any inconvenience.
*
Indicates required field
Participant's Name
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First
Last
Phone Number
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Email
*
Emergency Contact Name
*
First
Last
Emergency Contact Phone Number
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2nd Participant's Name
*
First
Last
Emergency Contact
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Emergency Contact Phone
*
3rd Participant's Name
*
First
Last
Emergency Contact
*
Emergency Contact Phone
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4th Participant's Name
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First
Last
Emergency Contact
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Emergency Contact Phone
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Choose Activities:
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4pm Science Club and Planetarium Show ($5)
6pm General Public Planetarium Show (Free)
7pm Simulated Space Mission ($10)
Comments?
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Photography Consent
I give the Challenger Learning Center of Lockport permission to use my child's name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of CLC of Lockport activities. I agree that CLC of Lockport has complete ownership of such pictures, etc., including the entire copyright, and may use them for any purpose consistent with the CLC of Lockport mission. These uses include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet.
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Yes, I give my permission.
No, I withhold permission.
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How did you hear about us? Choose all that apply.
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Lockport Union-Sun & Journal
WNY Family Magazine
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Space Missions
Public Space Missions
School Missions
>
Field trip schedule
BOCES Forms
Virtual Missions
Planetarium
BOCES Forms
Planetarium rental schedule
Programs
Summer Camps
After School Programs
>
Registration
Birthday Parties
Extra Venue Activities (EVA's)
Scout Programs
STEM Resources
About Us
Calendar
What We Do
Challenger History
Our Crew
Board of Directors
F.A.Q.
Gallery
2024 Eclipse