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Saturday/Girls' Science Club 2023- Initial Intake Form
Important NOTICE:
The next Saturday Science Club session will be on June 3rd.
Details:
Email Ms. Steph,
mssteph@tfempowerment.org
, with questions.
Youth ages,
3.5 to 10 years of age
Saturdays, 12 to 3 pm (
Girls' Club is on
2nd Saturdays
, 2 to 4:30 pm
),
Shugah Baybees Child Development Center, 138th btwn ACP Jr Blvd & Lenox Ave
This form is an
initial intake
and RSVP form. If you have ALREADY completed this form please use,
https://forms.gle/ZvPBfteqbc5GHjCZ7
to RSVP for additional Saturday Science Club sessions in 2023.
Visit our website,
www.tfempowerment.org
, to learn more about us.
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to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Full Name of YOUTH PARTICIPANTS. Please list all children that will be participating in the session.
*
Your answer
Current Age of Youth Participant(s).
*
Your answer
The youth participant(s) is/are
*
Male
Female
Other:
Full
Name
and
Phone
number of ADULT COMPLETING THE FORM
*
Your answer
For the adult completing the form: What is your relationship to the child?
*
Your answer
What are your family's identifiers? Please share any cultural, ethnic, or religious that you would like to communicate with us.
Note: This question is NOT mandatory.
Your answer
YOUTH PARTICIPANT'S Zip Code
*
Your answer
Emergency Contact Information- List the
names
and contact
phone numbers
of people OTHER than yourself who are authorized to pick-up the youth participant or who can be contacted in the case of an emergency.
*
Your answer
How did you hear about Ms. Steph's Science Club?
Your answer
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