Budding Scientists Registration Form
2018-2019 Year will begin October 2, 2018
Student Information
Child's Name *
Your answer
Address *
Your answer
Gender
Child's Birthdate *
Your answer
Family Information
Guardian's Name *
Your answer
Relationship to Child *
Your answer
Primary Phone Number: *
Your answer
Secondary Phone Number:
Your answer
Work Phone Number:
Your answer
Email Adress *
Your answer
Guardian's Name #2 (optional)
Your answer
Additional Address
If guardian #'s residence is different from child
Your answer
Primary Phone Number:
Your answer
Secondary Phone Number:
Your answer
Work Phone Number:
Your answer
Email Adress
Your answer
Any Health, Dietary or Educational Comments:
Your answer
Program Selection *
Which day/days?
Required
A $50 non-refundable registration fee is required to hold your child's spot. You will receive a welcome e-mail and invoice via e-mail following completion of this form. Monthly Tuition is due the last day of prior month. October Tuition is due by September 30. Please contact Kelsey Bartosz at kbartosz@sciencebuff.org or 896.5200 x 204 with any questions. *
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