NERD Lab - Science Lab Registration Form

NERD Lab - Science Lab Registration

Please register for your STEM event by filling the form below.
***Step Up For Students should reserve funds through the EMA first and use "SUFS" coupon code. Pictures taken during event may be posted on social media. Refunds available until 5 days before event.***
Parent Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Students Name(s)*
Are you using Step Up For Students ?*

YesNo
By checking the box below, I understand that participation in NERD Lab's science labs involves inherent risks, including potential injury. I release and hold harmless NERD Lab, its staff, and affiliates from any and all liability related to my child's participation. I authorize NERD Lab to seek emergency medical treatment for my child if needed and accept responsibility for any associated costs. I grant NERD Lab permission to use photos or videos taken of my child during the labs for promotional purposes. I agree that my child will follow all rules and instructions provided by NERD Lab staff.*

I agree
Payments are processed through PayPal. You may pay using an existing PayPal account, or any major credit card / debit card.

My Products*

Forms of Energy - Jan 30th, 9-10:30a

$25.00 Quantity

Forms of Energy - Jan 30th, 1p-2:30p

$25.00 Quantity

Interdependence - Feb 20th, 9-10:30a

$25.00 Quantity

Interdependence - Feb 20th, 1p-2:30p

$25.00 Quantity

Mixtures and Solutions - Apr 17th, 9-10:30a

$25.00 Quantity

Mixtures and Solutions - Apr 17th, 1p-2:30p

$25.00 Quantity

Rate of Reactions - May 15th, 9-10:30a

$25.00 Quantity

Rate of Reactions - May 15th, 1p-2:30p

$25.00 Quantity

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Total

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