STEAMOPOLIS Participant Application
THIS IS THE FORM YOU USE TO ENROLL IN THE LAB!
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Please provide YOUR contact information, including NAME, PHONE NUMBER, and EMAIL ADDRESS.
Please fill out this form for each child that you are registering. *Multiple Child Discount of $10 per child per lab
Child's Date of Birth
Child's Home Address
Please provide the primary home mailing address of the child.
This helps us know how to serve all the districts better
USD 501 Topeka Public Schools
USD 437 Auburn/Washburn
USD 450 Shawnee Heights
USD 345 Seaman
Topeka Catholic Schools
What is your child's current school grade?
Each lab is $55. Hours are 8:30 am to 4:30 pm. Please see our FB page for program descriptions!! *NOTE: There does need to be a minimum of 12 students enrolled in each lab, or the lab will be cancelled.
Monday, January 20, 2020 "Art-o-polis" at Jardine Elementary School
Friday, February 21, 2020, "May the Force Be With You" at Jardine Elementary School
Monday, March 16, 2020, "That is WEIRD Science" at Jardine Elementary School
Guardian Contact Information
Please provide contact information for the child's legal guardians, including NAME, PHONE NUMBER, and EMAIL ADDRESS.
Pick Up Authorization
Please provide name and phone numbers for ALL adults authorized to pick up your child.
Medical, Social, or Behavior Information
If your child has special medical, social, or behavior needs, OR if you will be sending medication with your child, please provide all relevant information for your child. If you have a preference for a hospital in the event of an emergency, please indicate so HERE.
Please provide the name and contact information for your child's primary care physician.
Payment for labs
Pay through PayPal (an invoice will be sent to you by email)
STEAMOPOLIS requires a lot of paperwork to be filled out. Its no fun, and we're sorry. The forms are available on our website. Please check all of the following, to acknowledge that you understand that the paperwork has to be completed when your child is dropped off for the lab and that payment has to be received for your child to be enrolled. New paperwork is required for each school year, not calendar year. This school year is for 2019-2020. NOTE: Your child WILL NOT be allowed to stay at the lab, if we do not have the "program agreement" and payment.
I understand that I need to download the "program agreement" and bring it, filled out, to my child's first lab.
Terms and Conditions
I understand that this form is an application, and not a contract.
I understand that participation in this program includes legal obligations which are explicitly defined in separate agreements mentioned above, and I have read and accept those agreements, policies, releases, terms, and conditions.
I understand that my child is not "enrolled" until payment is made.
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