Experiential Ink Pod School Registration
Student's Name *
Name of Parent or Guardian *
Street Address *
City, Town, or Village *
State *
Zip Code *
Contact Phone Number *
Email address *
What school does your student attend? *
What grade is your student in? *
Is there a schedule that your student needs to adhere to? Please list below.
Please tell us a bit about your student and family!
What days are you interested in having your student attend the Pod School? *
What is the best arrival time for your family? *
What time would you want to pick your student up? *
In the event that you are unable to pick up your student, please list the names and phone numbers of 3 people to which Experiential Ink is allowed to release your student. ID's will be checked. *
Will you need financial assistance to attend our program?
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