2024 Registration Form

2024 ACTIVE BRAIN BORDEAUX Registration Form
Little Scientist Information
Little Scientist's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Parent/Guardian/Emergency Information
Name*

First NameLast Name
Cellphone Number*

Area CodePhone Number
E-mail*
example@example.com
Does the little scientist have any allergies, chronic illness, or medical conditions? If yes, please describe.
No allergy

2024 ACTIVE BRAIN BORDEAUX Registration Form