Summer Program Registration Form

Child Information

Child's Name

First NameLast Name

Birth Date

MonthDayYear

Grade (as of next school year)

Gender

Parent/Guardian Information

Name

First NameLast Name

Home Number

Format: (000) 000-0000.

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

Which session(s) does your child plan to attend (you can click more than one)?

Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.

I understand that my child will participate in hands-on STEM activities that may involve materials such as paint, water, slime, or food-based items and may get messy.

I allow photos/videos to be taken of my child during the program to be shared on Bridge Point's social media/website.

Informed Consent and Acknowledgement

I hereby give my approval for my child's participation in any and all activities prepared by Bridge Point and the Stark Library during the selected session(s).

Details and Information

Sessions will be a combination of an activity prepared by the Stark Library and an activity prepared by Bridge Point scheduled from 1:00 pm - 2:30 pm. If there are any further questions, don't hesitate to contact Bridge Point at (330) 484-3644 or bridgepointserves@gmail.com.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Spark & Shine Your Light Registration