EmailMe Form - STEM SATURDAYS PRE-REGISTRATION FORM

STEM SATURDAYS PRE-REGISTRATION FORM

Please complete the form below in order to pre-register for the upcoming STEM SATURDAYS Program on March 9, 2019. After you enter your information, select your package below and click submit. Please only click the submit button once. You will then be redirected to paypal to pay securely. After you have paid, your child will be successfully registered for the program. If you choose to pay for sessions in advance, then in the future you will only need to fill out this form to pre-register for an upcoming STEM SATURDAY Session, because you would have already paid. All you will need to do is fill out the information and click the submit button. If you pre-register and do not show up, you will not receive a refund as there are limited seats available.

Child's name for pre-registration *
First Last
Child's Sex *
Child's Age: *
Child's Grade: *
Child's School: *
Parent/Guardian's Name *
First Last
Parent/Guardian's Phone Number: *
### - ### - ####
Parent/Guardian's Email *

Confirm Email
Zip Code *
Please list the additional child(ren) below that you are registering:
If you are registering more than one child, please list the child(ren)'s name, sex, age, and grade for each child. You may list a MAX of 5 children total. You must pay for all children that you are pre-registering, in order to be successfully pre-registered.
2nd Child's name for pre-registration
First Last
Child's Sex
Child's Age:
Child's Grade:
Child's School:
3rd Child's name for pre-registration
First Last
Child's Sex
Child's Age:
Child's Grade:
Child's School:
4th Child's name for pre-registration
First Last
Child's Sex
Child's Age:
Child's Grade:
Child's School:
5th Child's name for pre-registration
First Last
Child's Sex
Child's Age:
Child's Grade:
Child's School:
Does your child(ren) have allergies? *
Yes
No
If YES, please list them:

Payments: Select your package below, by checking the box in which reflects the number of children you are pre-registering, and the amount of STEM NOLA Saturday sessions that you wish to pay for. You must pay for at least one session to be successfully registered.

	I'm Paying for One Child	I'm Paying for Two Children	I'm Paying for Three Children	I'm Paying for Four Children	I'm Paying for Five Children
Pay for 1 STEM SATURDAY Session
Pay in advance for 2 STEM SATURDAY Sessions
Pay in advance for 3 STEM SATURDAY Sessions
Pay in advance for 4 STEM SATURDAY Sessions
Pay in advance for 5 STEM SATURDAY Sessions
Pay in advance for 6 STEM SATURDAY Sessions

1 / 2

Please list the additional child(ren) below that you are registering: