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.
Please record the first and last names of the child(ren) you are signing up to attend the STEAMpunks Club
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
Age(s) of Child(ren)
Please record the age(s) of the child(ren) attending the STEAMpunks Club
Where can you or another parent/guardian be reached in case of emergency?
To receive updates about the STEAMpunks Club, please fill in a working email address
When the program ends, my child has permission to:
Please make sure you and your child discuss the plan ahead of time!
Get picked up by a parent or other care provider
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.
Anything else we should know?
We will provide a light snack during the program. Please note any health or allergy concerns below.
Can we take and use photographs of your child(ren) at STEAMpunks?
Yes - I hereby consent to the use of any photographs, video or audio clips of my child in news coverage or publicity for the Eager Free Public Library. This may include use in our newsletters, brochures, fliers, posters, and/or web pages.
No - I do not consent to the use of photographs, video or audio clips of my child(ren).
Will your child attend the activity day on Monday, March 13, 2017 from 1:00-3:00 p.m.?
Not this time, but please keep me on the list.
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