STEAMOPOLIS Participant Application
THIS IS THE FORM YOU USE TO ENROLL IN THE LAB!
Need help? Email Christina at christinaturner@manchester-school.com
Contact Information *
Please provide YOUR contact information, including NAME, PHONE NUMBER, and EMAIL ADDRESS.
Your answer
Child's Name *
Please fill out this form for each child that you are registering. *Multiple Child Discount of $10 per child per lab
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Home Address *
Please provide the primary home mailing address of the child.
Your answer
School District *
This helps us know how to serve all the districts better
Child's Grade *
What is your child's current school grade?
Attending Days: *
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.
Required
Untitled Title
Guardian Contact Information *
Please provide contact information for the child's legal guardians, including NAME, PHONE NUMBER, and EMAIL ADDRESS.
Your answer
Pick Up Authorization *
Please provide name and phone numbers for ALL adults authorized to pick up your child.
Your answer
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.
Your answer
Doctor Information *
Please provide the name and contact information for your child's primary care physician.
Your answer
Payment for labs *
Forms Required *
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.
Required
Terms and Conditions *
Required
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