After School Science Program Registration: Fall 2019-2020
Parent`s Last Name: *
Your answer
Parent`s First Name: *
Your answer
Parent`s Phone Number *
The phone number of a parent who we should call in an emergency (Parents must be available and reachable during their children's class).
Your answer
Emergency Phone Number: *
A number in case the parent cannot be reached
Your answer
Email Address: *
This will be used for important updates and communication regarding the current session.
Your answer
Student's Last Name *
Your answer
Student's First Name *
Your answer
School Student Attends: *
Your answer
Student's Grade in School: *
How did you hear about our program? *
Your answer
The After School Science Program meets between 4:30pm & 6:30pm on Mondays and Wednesdays. Select the Program you are registering for: *
Required
Select your preferred payment option:
Questions or Comments:
Your answer
After clicking submit, you will be prompted to make an online payment.


The cost for each child is $10 per individual session, $60 for 8 sessions, or $100 for 16 sessions. Siblings join for half price
Submit
Never submit passwords through Google Forms.
This form was created inside of Walder Science Center. Report Abuse