Public Missions Registration Form
Additional Information
COST
The cost is $6 per person per program for registrations received before 12:00 p.m. the day before the program. The cost is $8 per person per program for registrations received after 12:00 p.m. the day before the program. ALL participants pay the admission fee (children and adults). *Valentine's Day on the Red Planet requires a $20 upcharge per person (a total of $26 per person for pre-registration, $28 per person for late registration).

PRE-REGISTRATION
The registration form must be completed and submitted before 12:00 p.m. the day before the program to receive the discount ($6). Registration is complete and confirmed on receipt of completed registration form and full payment. Programs are limited in size; therefore, registrations will be processed on a first come, first serve basis. Registration after 12:00 p.m. the day before the program or at the door is also accepted, if space permits, and costs $8 per person per program.

CANCELLATIONS/REFUNDS
No refunds will be offered for Public Mission programs. For cancellations received at least 48 hours prior to any program, your registration fee may be applied to future Public Mission programs.

AUTHORIZED PICK-UP
All parents and authorized individuals must present photo identification when picking up your child(ren) and be listed as an authorized individual on the registration form.

CONTACT INFORMATION
Should you need additional information, please call (850) 645-7777, weekdays from 8:00 a.m. until 4:00 p.m. For content/curriculum information, contact our Education Manager at (850) 645-7787.
Participant Information
Participant 1 First Name *
Your answer
Participant 1 Last Name *
Your answer
Participant 1 Grade Level (if applicable)
Participant 1 Age *
Your answer
Participant 2 First Name
Your answer
Participant 2 Last Name
Your answer
Participant 2 Grade Level (if applicable)
Participant 2 Age
Your answer
Participant 3 First Name
Your answer
Participant 3 Last Name
Your answer
Participant 3 Grade Level (if applicable)
Participant 3 Age
Your answer
Participant 4 First Name
Your answer
Participant 4 Last Name
Your answer
Participant 4 Grade Level (if applicable)
Participant 4 Age
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Email Address *
Your answer
Cell Phone *
Your answer
Secondary Phone
Your answer
Program Selection
Please select the program. If a program is marked FULL/SOLD OUT, please select the program to be added to the waiting list.
Program Selection *
Required
Payment Information
Payment will be accepted in advance or at the door, if space permits. Pre-registration is complete on receipt of full payment. Registrations accepted on a first-come, first-serve basis. VISA, MasterCard, Discover, AMEX, FSUCard or cash only. Please do not mail cash. Cash may be dropped off at our administrative offices or the box office with a valid sale number during business hours.

Pre-Registration: # OF PROGRAMS x $6 PER PERSON
Late Registration: $8 PER PERSON
*Valentine's Day on the Red Planet Upcharge: $20 PER PERSON
Amount to be Charged *
Your answer
Method of Payment *
Payment Electronic Signature *
Your answer
Media Release
This is to certify that I, _____________, give permission to the Challenger Learning Center, Florida A&M University and Florida State University to photograph and/or videotape for use on their website, promotional brochures, social media or during a local newscast or print interview. I understand that all rights, title and interest in the photography used belong to the Challenger Learning Center, Florida A&M University and Florida State University and that I will receive no financial compensation for the use of these pictures and/or videotape. I further understand that the above agencies may edit, copy, alter, or revise the photographs and/or videotape for use on our website, promotional brochures, social media or during a local newscast or print interview and that the above agencies will retain control over the use and distribution of the photographs and/or videotape. I have read this form and I understand its meaning. *
Liability Release
I, _______________, hereby grant my child(ren) permission to attend the Challenger Learning Center's Public Mission program and release the CLC staff, Florida A&M University, Florida State University, instructors, employees, sponsors and the Challenger Learning Center of any and all liability connected with his/her/their attendance.
Liability Release Signature *
Your answer
Authorized Pick Up
Please note that all parents and authorized individuals must present photo identification when picking up a child.
My child will be picked up from the Challenger Learning Center by: *
Your answer
Policy Acknowledgement
I have read and understand the program information and policies, including the policy on cancellations.
Policy Acknowledgment Electronic Signature *
Your answer
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