LEAP!2025
Saturday, November 8, 2025 - 9am to 5 pm
Parent/Legal Guardian/Chaperone Name (This person is also the Primary Emergency Contact for that day)
*
Prefix
First Name
Middle Name
Last Name
Relationship to Student (e.g. Mom, Dad, Guardian, Teacher, etc.)
*
Relationship
Primary Phone Number (we must be able to contact you at this number on the day of the event in the case of an emergency)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Emergency Phone Number (just in case we can't reach you at the phone # above)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Primary Email
*
example@gmail.com
Confirm Primary Email
*
example@gmail.com
Student Name
*
First Name
Middle Name
Last Name
Preferred Name or "Nickname"
*
Student Current Grade Level
*
Ninth
Tenth
Eleventh
Twelfth
School Name
*
School
School Type
*
Please Select
Public School
Private School
Charter School
Home School
Other
What county is your school located in?
*
County
Does the student have any known disabilities or special needs (physical or learning)?
*
Yes
No
Please describe the disabilities and special needs in the box below if you clicked yes above.
Does the student have any allergies or special dietary needs?
*
Yes
No
Please describe the allergies or special dietary needs if you clicked "yes" above.
Photo / Video Consent: TSH activities and events may be photographed or videotaped for publication in TSH informational and promotional materials. Your child may appear in these photographs or videos. Please click one box below:
*
I give permission for photographs, video, and digital images of my child to be used without compensation by The Science House.
I do not give permission for photographs, video, and digital images of my child to be used.
Please download the following forms and complete them in their entirety. We will collected completed forms at registration on the day of the event. Once forms are downloaded, please click the green submit button below to complete your registration.
Submit
Should be Empty: