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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.
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Participant's Name
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Last
Phone Number
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Email
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Emergency Contact Name
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2nd Participant's Name
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First
Last
Emergency Contact
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Emergency Contact Phone
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3rd Participant's Name
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Last
Emergency Contact
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Emergency Contact Phone
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4th Participant's Name
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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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How did you hear about us? Choose all that apply.
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Send My Information
Calendar
About
Who We Are
Staff
Employment
>
Enrollment Agent
STEM Instructor
Board of Directors
Frequently Asked Questions
Gallery
Programs
Space Missions
>
Book a Mission
Virtual Missions
>
Sign up
Planetarium Shows
>
Book Planetarium
After School
>
Registration
Summer Camps
>
Summer camp registration
Birthday Parties
Scout Programs
Professional Development
Support Our Mission
Newsletter
Request a Quote
Membership
Volunteer
Donate
Press Room
Contact
STEM Resources