Wait List Form

Wait List Form

Fill out this form to receive an email when a spot opens for a program you are interested in. Emails will be sent on order of month waitlisted, you will have 24 hours to claim the spot
Program*
For After School Adventure Club, did you need school pickup too? If so, please indicate school below
Student Name*

First Name Last Name
Birth Date*

Month Day Year
Gender
Address

Unit

Street Address

City State / Province

Postal / Zip Code Country
Parent Name*

First Name Last Name
Parent E-mail*
Phone Number

Area Code Phone Number
Where did you hear about this program?

NewsletterFacebookFriendPosterCommunity EventGoogle
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Yes
Additional Comments:
If you have any questions please email: learn@explorescienceclub.com
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