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Omaha Children's Museum Pass Request
Date of planned Museum visit
*Requests must be made at least 48 hours in advance. The pass must be picked up and returned to the DSA office.
Number of Family Members Visiting the Museum
Max of 3 adults and 6 children per visit
Address Line 1
Address Line 2
Individual with Down syndrome
Birthday of Individual with Down Syndrome
Your Relationship to Individual with Down Syndrome
*This information is used for grant writing purposes.
$1 to $24 999
$25,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 to $149,999
$150,000 and greater
Prefer not to answer
Ethnicity of Individual with Down syndrome
This information is used for grant purposes. Please check all that apply.
American Indian or Alaska Native
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
Prefer Not To Answer
Are you a member of DSA?
If not, join us here - www.dsamidlands.org/get_involved/join-us