ROBOTICS
Registering for
*
Spring 2026
SELECT
*
Please Select
K
1
2
3
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8
Student's Full Name
*
First Name
Last Name
Student's Date of Birth
*
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Month
-
Day
Year
Grade
*
Please Select
1
2
3
4
5
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7
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School Info
*
School Name
School District
Mother Full Name
*
First Name
Last Name
Mother Email
*
example@example.com
Mother Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Father Full Name
*
First Name
Last Name
Father Email
*
example@example.com
Father Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Address
*
Street Address
Street Address Line 2
City
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State
Zip Code
Authorized Pickup
*
Mother (as mentioned above)
Father (as mentioned above)
Other
Relation to the child
*
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mandatory Pickup/Dropoff Policies and Procedures
*
Payment
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Resource Fee
Non-Refundable
$
75.00
Robotics & Coding
Spring 2026
$
575.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Consent & Acknowledgement
Please fill all the required fields
Liability Waiver
*
Refund Policy:
*
Makeup Class Policy:
*
Makeup Class Policy:
*
*
Date of Consent
*
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Month
/
Day
Year
Date
How did you hear about us?
*
Google
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WhatsApp
Email / GEM Newsletter
Friend
Attended an event at GEM
Walked in
Back to School Fair
Received postcard
Representative Called
Other
SUBMIT
How did you hear about us?
*
Additional Notes/Comments
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