Distant After-School Information Request Form

Please use this form to tell us about your school. A member of our office staff will contact you within two business days to discuss if Mad Science would be a good fit for your school.

Contact Information:

Contact Name:
Title:
School/Organization:
Address:
City:
State:   Zip:

County:
Phone:
Alternate Phone:
Email:
Contact Preference:  
Best time to reach me:
How did you hear about us?

School Information

Approximately how many students attend your school in grades K-6?
Does your school currently offer any after-school enrichment? Yes
 
Questions or comments:
          (Optional)
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