HSC REQUEST FORM

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Headwaters Science Center Request Form

Please complete the form below for school field trips, large group visits, and/or outreach requests.

If you have any questions, please call HSC at (218) 444-4472.

Click here to check HSC's calendar for availability

*please note, the calendar is updated each weekday*

Your Name prefix, Mr or Mrs?

Headwaters Science Center Request

Field Trip

Group Visit

Outreach to Event/Location

Contact Name

Requested Date of Visit - check Calendar on HSC website first

Group Visits & Field Trips: Check the arrival times that work for your group

9:30 AM

10:00 AM

10:30 AM

11:00 AM

11:30 AM

12:00 NOON

12:30 PM

1:00 PM

1:30 PM

2:00 PM

2:30 PM

3:00 PM

3:30 PM

4:00 PM

Outreach Requests: list off-site location, date, and timeframe, and any other detailed requests

Phone Number

Email Address

Name of School/Organization

School/Org Address

City, State, ZIP

Grade Level/Age of Children

Number of Children Attending

Number of Adults Attending

Field Trip/Group Visit: Stay and eat your lunch at HSC for an additional fee of $100.

Yes, please schedule my group upstairs for lunch

No, my group will not need to stay at HSC to have their lunch

N/A

Demonstration

No demo with this visit

Combustion

Cryogenics or State of Matter

Animal Menagerie

Mineral Detectives

Pushes and Pulls

Raptors Rule

Simple Circuits

Starlab

Sound and Light

Unique Properties of Water

Other: as discussed with HSC prior to visit

HSC will prepare an invoice. Please let HSC know how you would like to pay (purchase order, mail in payment, etc.)

Additional Notes

Headwaters Science Center
413 Beltrami Ave NW
Bemidji, MN 56601
US

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