STEAM School Co-op Waitlist Registration

STEAM School Co-op Waitlist Registration
Parent(s)*

First NameLast Name
First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (Cell)*

Area CodePhone Number
Phone Number (Home)

Area CodePhone Number
Email*
example@example.com
Please see our website for our updated parent packet, schedule and fees
Which option would you like to register your child(ren) for? Please choose all applicable days.*

MondayWednesday (Middle/High School)Thursday
Student Information
Student 1*

First NameLast Name
Preferred Pronouns
Birthday
Grade
What would you like us to know about your child? (Special needs, any diagnosis, best teaching practices, interests, etc.)
Please list any medical conditions or allergies
Student 2

First NameLast Name
Preferred pronouns
Birthday
Grade
What would you like is to know about your child? (Special needs, any diagnosis, best teaching practices, interests, etc.)
Please list any medical conditions or allergies
Student 3

First NameLast Name
Preferred pronouns
Birthday
Grade
What would you like is to know about your child? (Special needs, any diagnosis, best teaching practices, interests, etc.)
Please list any medical conditions or allergies
Student 4

First NameLast Name
Preferred pronouns
Grade
Birthday
What would you like us to know about your child? (Special needs, any diagnosis, best teaching practices, interests, etc.)
Please list any medical conditions or allergies

Student Information