Mad Science Workshop Booking Form
Please fill out the entire form to the best of your ability. Once we receive your form, you will receive a confirmation back from us.

Please note that by filling out this form, you are BOOKING an event. There is a $35.00 cancellation fee if you cancel your event within two weeks of event date, and a $75 cancellation fee for cancelling within 48 hours of event date.

If you do NOT receive an email from us within 2 business days, please email us at MadScienceRocks@gmail.com. Thanks!
Email address *
"Day of Event' Contact Name: *
Your answer
School/Organization Name: *
Your answer
Billing Address: *
Your answer
Do you want a Workshop at YOUR Location, or in our Mad Science Lab? *
Event Location (if different than Billing). Please include Street Address, City, and Zipcode:
Your answer
Will the Event be Indoors or Outdoors? ($25 fee for outdoors) *
Location Directions (Best Place to Park/Unload/etc) *
Your answer
Best “Day-of” Phone Number: *
Your answer
Customer Email: *
Your answer
Date Requested ($25 Last Minute Booking Fee will apply for bookings made within 1 week of event date) *
MM
/
DD
/
YYYY
Time(s) Requested: *
Time
:
Second Choice Date: *
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/
DD
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YYYY
Second Choice Time: *
Time
:
Number of Students *
Your answer
Grade of Students *
Required
Workshop Type: *
Required
Total Number of Workshops: *
Your answer
If having multiple Workshops: Will all Workshops be on the same day?
If having multiple Workshops: Will all Workshops be the same theme?
If having multiple Workshops: Will all Workshops be in the same room/location?
If having multiple Workshops, please type the DATES and THEMES in here:
Your answer
PRE-SCHOOL Workshop Choice:
ELEMENTARY Workshop Choice:
How did you hear about us?
Any Restrictions? (No Water/Electric nearby, No Fire Allowed)
Your answer
Anything else we need to know?
Your answer
I understand that by filling out this form, that I am committing to the dates in this form. If I need to cancel for any reason, I understand that I must do so at least 2 Weeks before the event date, or I will get charged a cancellation fee. Please initial below to confirm your booking. *
Your answer
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