Hands-On Learning Services
After-School Science Club
at Broadneck Elementary
Spring 2017 (6 week program)
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
Class Dates (Thursdays): March 30, April 6, 20, 27, May 4, 11
REGISTRATION WILL CLOSE WHEN SECTION IS FULL
Child's Name (Last, First)
Child's Grade
Child's Teacher
Parent/Guardian Name
Parent/Guardian email
Parent/Guardian Phone/Alternate Phone
Please indicate any allergies (i.e. food), or other health or behavioral concerns of which we should be aware.
Please provide the name and phone number of an emergency contact (other than above parent) 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)
May we take photos of your child at Science Club and use these photos for our website/facebook?
(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 Special 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 3:55 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, Broadneck 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
THIS CLASS IS FULL. REGISTRATION IS NOW CLOSED.
THIS CLASS IS FULL. REGISTRATION IS NOW CLOSED.
