CSSC Course Registration Form

Registration Form

Fill out the form carefully for registration You will receive a copy of the registration form CSSC will contact you the week before the program/event with more information Your payments are processed securely through Square Are you registering Siblings? Receive a 5% discount on each registration enter code: SIBLING5/ Please fill out one form for each child, and insert code each time. Visit www.childrensciencesociety.org for more information If you have any issues contact childrenssciencesociety@gmail.com
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Sex*
Parent Name*

First NameLast Name
Parent Contact E-mail*
example@example.com
Parent Mobile Number*
Format: (000) 000-0000.
Emergency Contact 1*

First NameLast Name
Emergency Contact 1 Mobile Number*
Format: (000) 000-0000.
Emergency Contact 1 Alternate Number
Format: (000) 000-0000.
Emergency Contact 2*

First NameLast Name
Emergency Contact 2 Mobile Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 Alternative Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your child suffer from any Medical Conditions?*
We expect participants to always be respectful, using our and others property and when participating in our programs. Participants are to behave in a responsible way that respects the rights and dignity of others.:• Participants take Responsibility for their actions.• Participants Respect themselves, each other, program equipment and the environment.• Participants will be Caring in their relationships with others. Participants should talk to a staff member if they are uncomfortable with any experiences or need assistance while in CSSC programs.
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CSSC Programs and Products (select at least one)*

Kidz Science Workshop- LIFT OFF! (Sun Jan 21, AGE 6-12)

Kidz Science Workshops. Each session has different theme. Choose your date. These sessions take place in the Field House at McLeod Athletic Park. 2 weeks notice for refund in the event of withdrawal.

$22.75CAD

Kidz Science Workshop- FEATHERED FREINDS (Sun Mar 24, AGE 6-12)

Kidz Science Workshops. Each session has different theme. Choose your date. These sessions take place in the Field House at McLeod Athletic Park. 2 weeks notice for refund in the event of withdrawal. 11/12 spots available

$22.75CAD

Kidz Science CAMP 1

Mon Jul 31 to Fri Aug 4, 9am-3pm, age 5-12. Join us for a week of science fun! Hands on learning with excursions to nearby parks (eg Penzer, Buckley). $275/child, teacher to child ratio 1:12 Pickup and Drop off Alice Brown Elementary. 3 weeks notice for full refund, 2 weeks 50% refund 0/12 spots available

$275.00CAD Quantity

Kidz Science CAMP 2

$275.00CAD

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$0.00CAD

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