Supplemental Learning Funds: Class Registration
If you would like to use a supplemental learning funding source to pay for your student's class or camp at Gizmo, please fill out this form to register them. We will reserve their spot in the class and send you an invoice which you can submit to your funding source.
Name of Funding Source
Examples: Empowering Parents, IHLA, Overture. Not sure if yours is offered? Submit a form anyway and we'll get in touch with you to discuss it.
Child's Name
First Name
Last Name
Child's Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Class or Camp
Please type the name of the class or camp you would like to register your child for.
Class Start Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
This helps us to identify the correct class!
Parent's Name
First Name
Last Name
Parent's Email
example@example.com
Parent's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Please list any allergies, medical conditions or limitations on activities:
Does your child have any unique needs or behaviors our staff should be aware of?
Individuals authorized to pick up child from Gizmo:
If child is 12 or older: Is your child authorized to sign themselves out?
Yes
No
Submit
Should be Empty: