Before and after School Program registration form

ATTENTION PARENTS:

If your child's school is closed due to weather, the Corona virus, or any other circumstances out of our control, the Extreme Science class will NOT be held that day. We will do everything we can to make these classes up. Due to our schedule with other schools and programs, this may not always be possible. No refunds are given (full or partial) due to school closures out of our control.

ATTENTION PARENTS:

Tell me and I forget

Teach me and I remember

Involve me and I learn

- Benjamin Franklin

Child's first name *

additional contact number

Child's last name *

Grade *

Parent(s) name: *

Parent/Guardian (alt) cell phone

Best number to text confirmation *

Complete the registration form below to register your child for the before or after school science program coming to your school.

You will receive a confirmation text

APPROXIMATELY ONE WEEK BEFORE class starts.

How would you like your child released at the end of class? *

Parent will COME IN to pick up child

Child will walk home on their own

Release child to onsite daycare

Release child to parking lot to meet parent

N/A - before school program

School name: *

We have found that some phones have a spam blocker loaded on them that will keep you from receiving your confirmation message along with any important scheduling messages from us. Please consider adding Extreme Science (509-892-7621) to your phones contacts to ensure you receive your confirmation text message.

Child's Teacher - enter last name only *

Parent/Guardian cell phone (1st contact)

PREFERRED DAY - Please refer to your registration form that your child brought home to see which days the program is being offered at YOUR school *

Monday

Tuesday

Wednesday

Thursday

Friday

If your first choice class is FULL and we need to add a class or move students around to fit everyone in, which OTHER days are you available? Check all that apply. *

Monday

Tuesday

Wednesday

Thursday

Friday

None

Do NOT send payment to your school. Payments are due on the FIRST DAY OF CLASS. You will receive a confirmation TEXT MESSAGE approximately one to two weeks PRIOR to the first day of class. For more information, you may text the word INFO to 509-892-7621 *

Read above statement, then Click to confirm

Comments:

If the form is not "submitting, ensure that all required (*) fields are filled. If you have any questions, please contact me.

Thanks!

Radical Rick

509-892-7621

Health concerns *