RI STEAM Month Pop-Up Registration
Please complete this quick form to register your family for one or more of our upcoming STEAM Pop-Ups across Rhode Island.
Parent/Guardian Information
Parent/Guardian Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Back
Next
Student Information
Student Name(s) (Example: “Sophia (Grade 5), Mateo (Grade 7)” or “Only attending as an adult”)
*
Student Grade(s)
*
Please Select
5th
6th
7th
8th
School or Organization (Optional)
How many total attendees (including adults)?
*
Back
Next
Event Selection
Which STEAM Pop-Up(s) will you attend?
*
Tuesday, Nov 4 – Workforce Development Hub, Central Falls (3–5 PM)
Saturday, Nov 8 – The Gateway Center at Roger Williams Park, Providence (10 AM–12 PM)
Wednesday, Nov 12 - The Black Box at The Met High School, Providence (3-5 PM)
Not Open to Public -Friday, Nov 14 - Boys & Girls Club of Warwick, (3-5 PM) MEMBERS ONLY
Thursday, Nov 20 - Waterfire Art Center (3-5 PM)
Saturday, Nov 22 - Centerville Bank Stadium (10 AM-12 PM)
Back
Next
Additional Information
How did you hear about this event?
*
Please Select
School
Friend/Family
Social Media
Flyer
Website
Other
Would you like to receive updates about future Winners’ Circle programs?
*
Please Select
Yes
No
Back
Next
Emergency Contact (Optional)
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Back
Next
Consent
Media Release Consent
*
I give permission for my child and/or myself to be photographed or recorded during the STEAM Pop-Up for use in future promotional materials by Winners’ Circle XR Academy, Inc. and its partners.
Parent/Guardian Signature
*
Submit
Should be Empty: