2024-2025 STEM Squad Registration
Student's Name
*
First Name Your Child Goes By
Date of Birth
*
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Month
-
Day
Year
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Age
*
Please Select
5
6
7
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9
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Current Grade
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Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Has your student previously participated in STEM Squad or Museum School?
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Yes
No
Select the class(es) below in which you would like to enroll your student. **Please note the dates, time and age for each session. Select the class that corresponds to your student's current grade level. All fees are non-refundable. We understand that unforeseen circumstances may arise, and we encourage you to carefully review the course description and schedule before registering.**
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Wild about STEM- October 14, 2024 9-11 AM
Kindergarten-2nd Grade Students
$
40.00
Wild about STEM- October 14, 2024 12-2 PM
3rd-5th Grade Students
$
40.00
Turkey Tech- November 25, 2024 9-11 AM
Kindergarten-2nd Grade Students
$
40.00
Turkey Tech- November 25, 2024 12-2 PM
3rd-5th Grade Students
$
40.00
Brrr-brilliant Winter STEM- December 23, 2024 9-11 AM
Kindergarten-2nd Grade Students
$
40.00
Brrr-brilliant Winter STEM- December 23, 2024 12-2 PM
3rd-5th Grade Students
$
40.00
Future Cities- February 10, 2025 9-11 AM
Kindergarten-2nd Grade Students
$
40.00
Future Cities- February 10, 2025 12-2 PM
3rd-5th Grade Students
$
40.00
Conservation Station- March 17, 2025 9-11 AM
Kindergarten-2nd Grade Students
$
40.00
Conservation Station- March 17, 2025 12-2 PM
3rd-5th Grade Students
$
40.00
Please provide any additional information that you think is important or may interfere with the student's ability to fully participate in class.
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Parents' Information
Parent/Guardian 1
Parent/Guardian 1
*
First Name
Last Name
Relationship to Child
*
E-mail
*
example@example.com
Phone
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian 2
Parent/Guardian 2
First Name
Last Name
Relationship to Child
E-mail
example@example.com
Phone
Home Address Same as Parent/Guardian 1?
Yes
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Emergency Contacts/Authorized Pickup
List the name of at least one person (other than parent/guardian) who can be contacted in the event of an emergency or illness if you cannot be reached. The first person listed must be within one hour of the Museum, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age.
Emergency Contact 1
Full Name
*
First Name
Last Name
Primary Phone Number
*
Relationship to Child
*
Emergency Contact 2
Full Name
First Name
Last Name
Primary Phone Number
Relationship to Child
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Medical / Health Information
Name of Physician
Physician's Phone Number
Is the student up-to-date on all immunizations?
*
No
Yes
Attach immunization record or waiver
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Does your child have any food, medication or environmental allergies?
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Yes
No
If yes, please list and explain
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0/150
Does your child’s allergy/allergies require FWMSH staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?
*
Yes
No
If yes, please email a completed FARE Form to dmackey@fwmsh.org
Does your child have a special health or medical condition?
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Yes
No
If yes, please explain
*
0/150
Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?
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Yes
No
If yes, please explain
*
0/150
List any additional information about your child that would be useful for staff to know, such as fears, eating habits, health concerns, IEP, or special routines.
*
0/200
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Payment and Statement of Understanding
Fort Worth Museum of Science and History has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment.
*
Type first and last name above to consent
Photos or video of students in STEM Squad classes may be taken for archival and/or promotional purposes by the Museum. No identification of students will ever be used.
*
Type first and last name above to consent
Tuition will be invoiced through Procare- our registration management system. Your student’s placement will be relinquished if the tuition fees are not paid within 2 business days of the due date listed on the invoice. Children may withdraw up until the tuition payment is made; tuition is non-refundable. There are no credits for missed classes. The Museum reserves the right to cancel any class that does not meet minimum enrollment; if a suitable alternate class is not available, a 100% refund of registration and tuition fees will be provided. If the Museum cancels class for any reason, other than minimum enrollment requirements, no refunds or make-up days will be offered. Registrations are not transferable between students.
*
Type first and last name above to consent
Sign Document
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Date Signed
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