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Science After School Registration

Name: Science After School Registration
SKU: SASREG
Price: 30.00 USD
Availability: InStock

Your Childs Full Name*

Street Address*

City*

State*

Zipcode*

Date of Birth*

Gender*

Male

Female

Rather Not Say

Ethnicity*

African American

Hispanic

Caucasian

Rather Not Say

Name of School*

Phone Number*

Grade*

Parent/Guardian Information

Who Does the Child Live With?*

Mother

Father

Both Parents

Guardian

Parent/Guardian Name*

Email*

Primary Number*

Work Number*

Place of Employment*

Additional Parental Information

Parent/Guardian Name

Primary Number

Work Number

Place of Employment

Emergency Contact Information

Emergency Contact Name*

Primary Number*

Work Number*

Address*

Relationship to Child*

Additional Emergency Contact

Emergency Contact Name

Primary Number

Work Number

Address

Relationship to Child

Authorized Pick-Up

Authorized for Pick-Up*

Phone Number*

Relationship to Child*

Authorized for Pick-Up

Phone Number

Relationship to Child

Unauthorized Pick-Up

Medical Information

Information reported is for staff and emergency personnel only.

Physician's Name*

Physician's Phone*

Does Your Child Have Allergies?*

Yes

If Yes Please list:

Does Your Child Take Medications?*

Yes

Medications

Please describe any additional behavioral cognitive or medical information regarding your child.

You're All Set!

You will be redirected to the Science After School Days once you add your registration to the cart.

The cost for Science After School is $10 per day. A one-time $30 registration fee is required. Parents/Guardians must complete the registration form and the Science After School Handbook prior to fulfilling enrollment.

Once you have registered your child, you will be redirected to the Science After School Days page where you can select the days you would like your child to attend.

Already Registered for Science After School? Click here to Login!

Hours

Tues. - Sat.: 9AM - 5PM
Sun.: 1PM - 5PM

Location

500 Mid America Blvd.
Hot Springs, AR 71913
(501) 767-3461

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The mission of Mid-America Science Museum is to stimulate interest in science, to promote public understanding of the sciences, and to encourage life-long science education through interactive exhibits and programs.

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