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Child's First Name: Child's Last Name:
Child's Gender (M or F): Child's Age (6-12):

There will be two sessions for Science Day, session "A" will run from 9:00 AM-12:00 PM and the session "B" wil run from 1:30 PM- 4:30 PM.
Session Selection (A or B):

Parent/Guardian First Name: Last Name:
Parent/Guardian Phone Number (555) 555-5555:
Parent/Guardian e-mail address:

If possible, I would like my child paired with (children will be grouped by age unless specified):
First Name: Last Name:

Pertinent Allergies :
(We will be serving a small snack and juice and water)


If the child will not be picked up by the Parent/Guardian listed above, please provide the name of the individual that will be picking them up at the end of the day (this can be edited on the day of the event).
First: Last:
Phone Number (555) 555-5555: