Super Science Sunday Registration: Winter 2018-19
Parent Last Name: *
Your answer
Parent First Name: *
Your answer
Parent Phone Number *
The phone number of a parent who we should call in an emergency (Parents must be available and reachable during their children's class).
Your answer
Emergency Phone Number: *
A number in case a parent cannot be reached
Your answer
School(s) Your Children Attend: *
Please list the elementary and/or middle schools attended by registrants.
Your answer
Email Address: *
This will be used for important updates and communication regarding the current session.
Your answer
How did you hear about our program? *
Your answer
Girls Registration Grades 1 - 6
Skip this section if you are not registering girls in grades 1 - 6.
First Names of Girl Participants in Grades 1 - 6:
Program runs from 10:15AM - 11:30AM
Your answer
Grades in School of Girl Participants:
Check all that apply. For safety reasons, kindergartners (despite age or level) will not be accepted into the program.
Choose all the dates that your child will be attending the program.
Feb 3rd
Feb 10th
Feb 17th
Feb 24th
Mar 3rd
Mar 10th
Mar 17th
Mar 24th
Mar 31st
Boys Registration Grades 1 - 3
Skip this section if you are not registering boys in grades 1 - 3.
First Names of Boy Participants in Grades 1 - 3:
Program is 3:30PM - 4:45PM
Your answer
Grades in School:
Check all that apply. For safety reasons, kindergartners (despite age or level) will not be accepted into the program.
Choose all the dates that your child will be attending the program.
Feb 3rd
Feb 10th
Feb 17th
Feb 24th
Mar 3rd
Mar 10th
Mar 17th
Mar 24th
Mar 31st
Boys Grades 4 - 6 Registration
Skip this section if you are not registering boys in grades 4 - 6.
First Names of Boy Participants in Grades 4 - 6:
Program is 1:45PM - 3:00PM (Early Drop off at 1:30)
Your answer
Grades in School:
Check all that apply.
Choose all the dates that your child will be attending the program.
Feb 3rd
Feb 10th
Feb 17th
Feb 24th
Mar 3rd
Mar 10th
Mar 17th
Mar 24th
Mar 31st
Questions or Comments:
Your answer
After clicking submit, you will be prompted to make an online payment.
Each Sunday Program is $12 per child or $102 for all nine Sundays.

Discounts for multiple children enrolled:
$198 for all nine Sundays for two children
$294 for all nine Sundays for three children

Submit
Never submit passwords through Google Forms.
This form was created inside of Walder Science Center. Report Abuse - Terms of Service