Registration

Science Adventure Program Registration Form

* Indicates required field

Name of Child *

First

Last

Current Age *

DOB *

Sign Me Up For These Programs *

Parent/Guardian #1 *

First

Last

Email *

Home Phone *

Cell Phone *

Relationship to Child *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian #2 *

First

Last

Email *

Home Phone *

Cell Phone *

Relationship to Child *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact (if different from above) *

First

Last

Email *

Home Phone *

Cell Phone *

Relationship to Child *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Child Profile - Please tell us about your child to help us meet his or her individual needs.

What would you like most for your child to experience with Science Adventure Program? *

How does your child react to change (such as starting a new program, etc.)? *

What do you enjoy the most about your child? *

What types of activities does your child enjoy doing the most? *

How would you describe your child (personality characteristics)? *

Is there anything else you would like to tell us so we can better meet his/her needs? *

By entering my full name and current date below I acknowledge that I have a clear understanding of and agree to the policies of Science Adventure Program, LLC.

Full Name *

Current Date *

Submit

Please Download, Print and Sign:
- Authorization for Medical Treatment of a Minor
- Authorization for Transportation or Emergency
- Liability Waiver

sap_policies_medical_and_liability_forms.docx
File Size:	501 kb
File Type:	docx

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