After School Program Registration - Winter 2021
Parent`s Last Name: *
Parent`s First Name: *
Parent`s Phone Number *
Email Address: *
This will be used for important updates and communication regarding the current session.
Address: *
Student's Last Name *
Student's First Name *
School Student Attends: *
Student's Grade in School: *
Select the Program you are registering for: *
Required
How did you hear about our program? (Please select all that apply) *
Required
Questions or Comments:
After clicking submit, you will be prompted to make an online payment.


The cost for each program is $52 for the first 4 weeks, or $128 for all 11 weeks of the winter sessions. Monthly payment plans available. Siblings join for half price.
Submit
Never submit passwords through Google Forms.
This form was created inside of Walder Science Center. Report Abuse