Homeschool-Science Adventures Mondays 2022-23 (ages 9-13)

2022/23 REGISTRATION FORM

Please complete one form per child.

***Please provide us an email address that you routinely check - it is what we will use for program communication***

Thank You!

Membership status

Are you a Fern Hollow member?

Yes, I am a member

No, I am not a member

Not a member? Join today!

CLICK TO PURCHASE A MEMBERSHIP

Member Name

First Name

Last Name

Participant Information

Please fill out this form for each of your children if you have multiple participating in programs.

Child's Full name

First Name

Last Name

Child's participation history

Is this your child's first program with us in 2022?

Yes

Permission and Waiver Forms / Policies and Procedures

If this is your child's first program at Fern Hollow in 2022, you need to fill out one Fall 2022 Waiver and Permission Form AND one Fall 2022 Policies and Procedures Form per child. Please click on the links below. You may complete the forms after you submit your registration.

Fall 2022 Waiver and Permission Form

Fall 2022 Policies and Procedures

Child's Age

Child's Birthday

(mm/dd/yyyy)

Current grade (2022-2023 school year)

Emergency Contact Name

Please provide the full name of who to contact in case of an emergency.

Emergency Contact phone number

Please provide the phone number of your emergency contact

Electronic Signature

By writing my name below, I certify that I have read the above information. My signature also certifies my understanding of and agreement with the above policies. The information provided is correct to the best of my knowledge.

First & Last Name

First Name

Last Name

Contact Phone

Contact email

Verify Email

Date

(mm/dd/yyyy)

PAYMENT

Homeschool-Science Adventures Mondays 2022-23 - Registration Fee.

Science Adventures Mondays 2022-23 - PUBLIC FEE *	Quantity
$200 - Ten (10) sessions - Public fee
$23 - Single (1) session - Public fee

Science Adventures Mondays 2022-23 - MEMBER FEE *	Quantity
$175 - Ten (10) sessions - Member fee
$20 - Single (1) session - Member fee

Add 3% to my total amount to help cover the payment processing fees