Little Sparks Registration
Email address *
Which session? *
Name *
Your answer
Email *
Your answer
Phone *
Your answer
Home Address *
Your answer
Name of Child *
Your answer
Gender *
Your answer
Age of child on Sept 1, 2017 *
Your answer
Is your child currently attending preschool? If yes, note which preschool: *
Your answer
Allergies or other information we should know that might impact your child's learning experience?
Your answer
Is there anyone else who may pick up your child? Include name and phone number
Your answer
In the event of an emergency whom should we contact? Include name and phone number
Your answer
Payment can be payment via check made payable to the Maritime Explorium. Full payment due at registration. Registration is not confirmed unless full payment is received. Cancellation of program requires 21 days notice in writing. *
Any questions or comments?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Maritime Explorium. Report Abuse - Terms of Service - Additional Terms