Educator Eligibility Form
Please complete the educator form below to confirm your eligibility to reserve the classroom. Once it's approved, a Verge staff member will follow-up with you and share a link to our online appointment scheduling system.

We look forward to connecting with you!
Email address *
CONTACT INFORMATION
First Name *
Last Name *
Phone *
SCHOOL INFORMATION
School *
Job Position *
Number of Students Served *
Zip Code *
Anything else you’d like us to know?
I understand that the classroom reservation is contingent on upholding and abiding by all classroom rules of use. Verge Center for the Arts reserves the right to refuse a classroom reservation for the falsification of any information. I understand that I am responsible for all damage to the classroom caused by, or as a direct result of my reservation. This specifically includes damage to art, audiovisual equipment, furnishings, and bathrooms, as well as lost revenues due to damage. I agree to indemnify, defend and hold harmless Verge Center for the Arts and its officers, agents, and employees for any and all liabilities, claims, errors, omissions, losses, accidents, and expenses caused by, arising out of, or in connection with, either directory or indirectly, use of the Verge classroom space. Terms subject to change.
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Verge Center for the Arts. Report Abuse