Hands-On Learning Services
After-School Science Club at 
Millersville Elementary
 Spring 2017
Thursdays. 3:30-4:30.
Class Dates: February 9, 16, 23, March 9, 16, 23, 30, April 6
Registration Form
Directions:  Please fill out this from completely and click the "submit" button at the bottom of the page.  You will be directed to the payment page after submitting your registration information
Child's Name (Last, First)
Child's Grade
Child's Teacher
Parent/Guardian Name
Parent/Guardian email
Parent/Guardian Phone/Alternate Phone
If you indicated than any of the children registered have allergies or other health/behavioral concerns, please explain in the box below.  If there are no such concerns, leave the box blank.
Please provide the name and phone number of an emergency contact OTHER THAN THE PARENT/GUARDIAN we should call in the case that we are not able to reach the parent or guardian
Emergency Contact Name
Emergency Contact Phone
Who will be picking your child up from Science Club? (name/relationship to child OR indicate if child attends school-based aftercare)
May we take photos of your child at Science Club and use these photos for our website/social media?
(we will not identify children by name without direct authorization from parent)
It is our policy that all medications- prescription and/or over-the-counter- must be administered at home.  We will not administer or permit on the premises prescription or over-the-counter medications at Fantastic Friday Science.  The only exceptions are emergency medications such as epi pens and athsma inhalers.
Other Information.
Behavior Policy: Children must be respectful of school property, the teacher and him/herself and behave appropriately at all times. If at any time the teacher feels that a student is disruptive to the class, that child will have to leave the program WITH NO REFUND. There are no exceptions.

Late Policy: Children must be picked up PROMPTLY at 4:30 pm. If you are late to pick up your child, you will pay $1.00 per minute that you are late. This money is due directly to the teacher and is due immediately. Failure to pay for minutes late will result in expulsion from the program.

I understand the above policies and agree to abide by the decision of Hands-On Learning Services. I, as parent/guardian of the above referenced child/children, give my permission for my child to participate in the after-school science club.  I do not hold Hands-On Learning Services, Millersville Elementary, or AACPS liable in any way. I understand that I will not receive a refund if my child is asked to leave the program. 
Other Special Instructions or Requests:
You will be directed to the payment page after submitting your registration information
Select the program(s) for which you are registering and the number of students for each program:
All About Animals
If You Build It...
SCHOLARSHIPS
One of our aims is to make our programming accessible to all students.  To help us realize this goal, we are offering a limited number of need-based scholarships each semester.  Each scholarship will cover the full cost of one tuition for one semester.  These scholarships are awarded to qualified applicants through a lottery process.  If you think that you may qualify, please click the button below and complete the application.  Scholarship awardees will be notified and directed to the registration page at that time.
​Are there any allergies/ health/behavioral concerns?  (if yes, explain below)
May we text to any of the phone numbers provided? 
(text messages may be sent to provide information regarding classes, not for advertising)
PAYMENT INFORMATION
You can elect to pay in-full now or through an installment plan. If you choose the installment plan, you will be required to pay a $50 deposit now and the rest in two additional installments, the first will be due after week 2 (at least 50%), the final will be after week 5 (100%).  Installment plans can be paid via check or online.
Please indicate whether you will be paying in full or through the installment plan:
MILLERSVILLE GOOD SAMARITAN FUND
We are offering full-tuition scholarships so that students from families who might not be able to otherwise participate in science club will be able to do so.  In addition to this, we are establishing a "fund" to which other Millersville families can contribute and these funds will be used to generate additional scholarships.  This program is completely voluntary and donors and recipients will be kept anonymous.  
Please indicate whether you intend to contribute to this fund 
(if you choose "yes," you can make your donation on the payment page):
I agree to these policies
YES
NO
YES
NO
IN-FULL
INSTALLMENT PLAN
YES
NO