Hands-On Learning Services
Fantastic Friday Science
2011-2012
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
I, as parent/guardian of the above referenced child/children, give my permission for my child to participate in Fantastic Friday Science. I have read, understand, and will adhere to all policies oultined above, including but not limited to the medication policy.Further, I understand, agree to, and accept the policies of Hands-On Learning Services, with the understanding that neither the facilitators of this event nor AACPS, nor Eastport Elementary School are responsible for lost articles or injury.
Child's Name: LAST, FIRST
Child's grade (N/A, PK, K, 1)
Child's school (if applicable)
Parent/Guardian Name (please provide first and last)
Parent/Guardian Email Address
Parent/Guardian Phone number
Alternate/Cell Phone Number
Please provide the NAME and PHONE NUMBER of an EMERGENCY CONTACT that we should call in case we cannot reach the parent/guardian listed above.
Emergency contact name
Emergency contact phone number
If you know ahead of time that someone other than parent/guardian will be dropping off or picking up your child/children from Friday Science, please indicate below the name of the person who will be doing so
Name of drop off/pick up person
Health Information
Does your child have any food allergies or other health concerns (physical, behavioral, emotional, etc) that we should know about?
If yes, please explain below.
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.
Medication Policy
Photo release
Hands-On Learning, LLC, has my permission to take photos of my child during Summer Science and to post the photos on the company website
Special Instructions & Requests please enter if applicable
Signed,
To complete registration, please click the submit button below. After submitting, you will be directed to the payment page to complete the process.
Costs and fees schedule
Please select ALL of the sessions for which you are registering (2011-2012 school year):
Total Number of sessions for which you are registering at this time:
How many children (from the same family) are you enrolling at this time?
1
2
3
# sessions12345678# kids
1 $30 60 90 120 150 180 210 2252 $55 110 165 220 275 330 385 4403 $80 160 240 320 400 480 560 640