ROBOTICS
Registering for
*
Spring 2026
SELECT
*
Please Select
K
1
2
3
4
5
6
7
8
Student's Full Name
*
First Name
Last Name
Student's Date of Birth
*
-
Month
-
Day
Year
Grade
*
Please Select
1
2
3
4
5
6
7
8
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
Please Select
Alabama
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District of Columbia
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Oregon
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South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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
$
75.00
Robotics & Coding
Spring 2026
$575.00
$
575.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Consent & Acknowledgement
Please fill all the required fields
Liability Waiver
*
Refund Policy:
*
Makeup Class Policy:
*
Makeup Class Policy:
*
*
Date of Consent
*
/
Month
/
Day
Year
Date
How did you hear about us?
*
Google
Facebook
Instagram
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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