Virtual History Registration

Teacher Name:*
Teacher Phone Number:*
Please include the area code.
Teacher E-mail:*
School Name:
Grade Level:*
- Elementary: Life 100 Years Ago
- Middle School: First to Flip, First to Flush
- High School: Orange as a Final Frontier
Number of Students:*
Kits are subject to availability*
The W.H. Stark House’s Virtual History Program Kits are subject to availability. Reservations are not complete until a staff member confirms your reservation.
I understand my reservation is not complete until it is confirmed by a staff member.
Liability Statement*
BY RESERVING THIS KIT, THE SCHOOL AND/OR HOMESCHOOL PARENT ASSUMES ALL RISK INCIDENT TO THE USE OF KIT SUPPLIES INCLUDING BUT NOT LIMITED TO PROPERTY DAMAGE AND PERSONAL INJURY, AND BY RESERVING THIS KIT NOW AGREE TO RELEASE THE W.H. STARK HOUSE AND THE STARK FOUNDATION, OUR AGENTS, AND RELATED ENTITIES FROM ALL LIABILITY FOR ANY LOSS, INJURY, OR DAMAGE THAT YOU MAY SUSTAIN, EVEN IF THE LOSS, INJURY, OR DAMAGE IS CAUSED BY OUR SOLE NEGLIGENCE OR FAULT.
I have read and acknowledge the Liability Statement.