After-School Classes Registration Form

Student Information:

Full Name: Date of Birth: Grade Level/Teacher: School Name:

Parent/Guardian Information:

Full Name: Email Address: Phone Number: Can we put you on our mailing list for program updates? Y/N:

Class Selection:

STEM Jr. Engineers (Grades K-2) Tuesday’s 3:30-4:30 Creative Arts (Grades K-4) Thursday 3:30-4:30 Creative Arts (Grades 5-8) Thursday 3:30-4:30 Jr. Robotics & Coding (Grades 3-4) Tuesday 3:30-4:30

Additional Information:

Does your child have any allergies or medical conditions we should be aware of? No Any special accommodation needed?

Payment Information:

Program Fee: $125 for a 6-week session (Includes all materials and supplies)

Consent & Waiver:

By checking this box, I agree to the terms and conditions, including the liability waiver and photo consent for promotional use. Parent/Guardian Signature: