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*
Emergency Contact 1*

First NameLast Name
Emergency Contact 1 Mobile Number*
Emergency Contact 1 Alternate Number
Emergency Contact 2*

First NameLast Name
Emergency Contact 2 Mobile Number*
Please enter a valid phone number.
Emergency Contact 2 Alternative Number
Please enter a valid phone number.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your child suffer from any Medical Conditions?*
All children are expected to adhere to CSSC's code for student conduct. Please indicate you have read and understood student expectations:*

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.
Where did you here about this program?

CSSC FacebookFriend or social media shareCSSC NewsletterExplore Science ClubPoster
Name of Signatory*

First NameLast Name
Is the Signatory authorized to sign on behalf of this child?*

YesNo

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

Enter coupon

Total

$0.00CAD

Credit Card

Signature

Clear
Should be Empty: