Stem Super Kids - Enrolment Form

Stem Super Kids - Enrolment Form

Welcome to STEM Super Kids! Please fill out this form to register your child for the Holiday Workshop on 10th July or Term 3 weekly classes starting from 15th July. For more information, visit www.stemsuperkids.com or email us at info.stemsuperkids@gmail.com.
Student Details:
Full Name*

First NameLast Name
Age of Child*
Date of Birth*

DayMonthYear
Year Level*
Parent/Guardian Details:
Full Name*

First NameLast Name
Phone Number*
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Relationship to Child*
Email*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact (if different from above):
Full Name

First NameLast Name
Phone Number
Relationship to Child
Program Selection*

One time registration - $20Weekly Science classes (Per Term) - $120Weekly Vedic Maths classes (Per Term) - $120
Total Amount Payable (Invoice will be sent by email)
Declaration and Consent:

I, the parent/guardian of the above-named child, give permission for my child to participate in STEM Super Kids programs. I understand that all reasonable precautions will be taken for safety, and I have disclosed relevant medical information.

By entering my name below, I confirm my consent.
Media Consent*

I consent to photos/videos of my child being used for promotional purposeI do not consent
Full Name*

First NameLast Name
Signature*

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Date

MonthDayYear
Date
Please verify that you are human*
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