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Saturday Science Event Registration
Session 1: May 5-October 20 2018, every first and third Saturday, 9 AM- 2PM

Event Address: 515 N University Ave, Provo, UT 84601 (House of Trix, The Historical BYU Women's Gymnasium)

This registration form is for students with Down syndrome, ages 14 and up, who are wanting to participate in the Saturday Science Initiative.

IMPORTANT PAYMENT INFORMATION:
* As this is a new initiative, we are currently working on getting an online payment system put together. For now, we ask that you pay through Venmo (@wonderwoodacademy-nonprofit), or through cash or check before the first day of the program. We appreciate your understanding and patience in this regard.
* There are a fixed number of spots available for this program (24 young adults with Down syndrome), and the submission of this form will reserve you one of those spots. Until the payment has been made, there will be no confirmation of your spot in the program; the payment is the confirmation. If payment has not been submitted before the deadline of April 20th at midnight (for Venmo payments; if paying through cash or check, the payment will be due the first day of the program), you will be unable to participate. Failure to pay will result in loss of spot reservation and participation in the program.
* If you sign up and realize this won't work for you, please let us know as soon as possible. There will be NO PRORATION and NO REFUNDS after the start of the first class (9 am, May 5th, 2018).

If you think it might be too late to claim one of the 24 spots for this upcoming session, fill out the form anyway! This program will happen again and again every 6 months, and you can reserve your spot for the next session (beginning in November 2018).

Note that the Wonderwood Foundation Waiver will need to be printed, filled out, and turned in the first day of the program.

Please contact the program manager, McKay Reese, at 949-412-2003 or mdreese146@gmail.com if you have any questions or concerns.

Name *
Your answer
Age *
Your answer
Email *
Your answer
Gender *
Name of parent or legal guardian (Please specify if you are a parent or a legal guardian) *
Your answer
Address: *
Your answer
Emergency phone contact (Please list 2): *
Your answer
Students may be checked in and out of the program by the following individuals: *
Your answer
Does the student have any health issues that may affect his or her safety when walking, running, jumping, or climbing, such as a heart problem, bone or joint disorders, low muscle strength, recent injuries, or problems with vision, hearing, or balance? *
If the student has Down syndrome, has he or she ever been checked by a physician for atlanto-axial instability and told that there may be a degree of instability? *
Does the student have sensory issues or behavioral issues that could result in a hesitance to touch unusual objects, dislike of sounds or situations, difficulty getting along with others, tendency to leave the group without permission, becoming angry in typical settings, endangering him- or herself or others, destruction of property, failure to hear instructions or see materials, or develop unusual stress levels in atypical setting? *
If you answered yes to any of the above questions, please explain in some detail:
Your answer
Please Select the Child's Ability to Read: *
Required
Please describe the student’s ability to focus on an interesting sedentary activity: *
Please use this link to print and fill out the Wonderwood Foundation Waiver and media release (https://drive.google.com/open?id=0B5OcfIdx8dnYQU16dFJyeWtOQzJzbmtFNk94ZEU1R0hLUHQw) *
Please use the following link to sign the waiver for House of Trix: http://www.houseoftrix.info/ *
Required
I have made the $360 payment through Venmo *
Submit
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