EmailMe Form - Hands on Science Registration for ONE Participant

Parent Email *
Phone *
### - ### - ####
Parent Name / Contact Person *
First Last
Child's Name *
First Last
Child's Age *
Select school *
Checkbox *
Check box to register one student ( Cost $37.50)
Check lunch if desired
Optional Lunch 3.50
You can save by pre-paying lunch. This is optional. You can bring lunch or buy lunch day of the event
FIRST CHOICE *
Unless noted all classes are for all ages and students will be in age appropriate groups.
SECOND CHOICE *
Unless noted all classes are for all ages and students will be in age appropriate groups.
THIRD CHOICE *
Unless noted all classes are for all ages and students will be in age appropriate groups.
FOURTH CHOICE *
Unless noted all classes are for all ages and students will be in age appropriate groups.
FIFTH CHOICE *
Unless noted all classes are for all ages and students will be in age appropriate groups.
SIXTH CHOICE *
Unless noted all classes are for all ages and students will be in age appropriate groups.
SEVENTH CHOICE *
Unless noted all classes are for all ages and students will be in age appropriate groups.
SURPRISE SPECIALTY WORKSHOP *
Yes if available I would like my child to partipate
No thanks we will pass
From time to time we have a guest teacher with a class not on our list. if you would like your child to be selected to be a part of this "surprise" workshop check yes, if not check no.
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Optional Tax Deductible Donation
$ Dollars . Cents