STEAMpunks Registration 2016-2017
Registration form for the library's STEAMpunks Club. STEAMpunks is a popular hands-on program offered on days off of school that incorporates science, technology, engineering, arts and math for kids in grades K-5. Call with questions: (608) 882-2260.
Child(ren) Name(s)
Please record the first and last names of the child(ren) you are signing up to attend the STEAMpunks Club
Your answer
Parent/Legal Guardian Name
Please record the first and last names of parents and legal guardians of the child(ren) you are signing up to attend the STEAMpunks Club
Your answer
Age(s) of Child(ren)
Please record the age(s) of the child(ren) attending the STEAMpunks Club
Your answer
Phone Number
Where can you or another parent/guardian be reached in case of emergency?
Your answer
Email Address
To receive updates about the STEAMpunks Club, please fill in a working email address
Your answer
When the program ends, my child has permission to:
Please make sure you and your child discuss the plan ahead of time!
Who has permission to pick up your child?
If anyone besides a parent/guardian is picking up your child, please record their first and last name. Please note: children will be asked to stay in the program room until their ride is here.
Your answer
Anything else we should know?
We will provide a light snack during the program. Please note any health or allergy concerns below.
Your answer
Photo/Video/Audio Release
Can we take and use photographs of your child(ren) at STEAMpunks?
Will your child attend the activity day on Monday, April 17, 2017 from 1:00-3:00 p.m.?
Required
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