After School Science Program Registration: Winter 2020
Parent`s Last Name:
Parent`s First Name:
Parent`s 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).
Emergency Phone Number:
A number in case the parent cannot be reached
This will be used for important updates and communication regarding the current session.
Student's Last Name
Student's First Name
School Student Attends:
Student's Grade in School:
The After School Science Program meets between 4:30pm & 6:30pm on Mondays and Wednesdays. Select the Program you are registering for:
Girls After School Science: Mondays and Wednesdays
Girls After School Science: Mondays Only
Girls After School Science: Wednesdays Only
Boys After School Science: Mondays and Wednesdays
Boys After School Science: Mondays Only
Boys After School Science: Wednesdays Only
Select your preferred payment option:
$10 per session
$60 for 8 sessions
$100 for 16 sessions
How did you hear about our program? (Please select all that apply)
Aneinu Community E-mail
E-mails from Walder Science
Flyers in Shuls
Voice E-mail Blast
Questions or Comments:
After clicking submit, you will be prompted to make an online payment.
The cost for each child is $10 per individual session, $60 for 8 sessions, or $100 for 16 sessions. Siblings join for half price
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This form was created inside of Walder Science Center.