TES Summer Program Registration Form

TES' Academic's STEMAA 2021 Registration Form

Please complete each section of the application to register your child/children for Teaching Empowering Strengthening's (TES) STEMAA Program. Sessions will take place on Saturdays, 1:00 pm - 4:00 pm from June 26, 2021 until August 21, 2021 (No session July 3, 2021). All participants must wear a mask and COVID temperature checks will take place during check-in. The $50 registration fee is due July 1, 2021. Program Fees of $170 is due June 25th and July 31st.
Child(ren)'s Information
Child/Children's Full Name *
please include all children you want to register
Child/children's Date of Birth *
ie. David - 12/15/10
Child/children's Grade *
ie. David - 4th grade
School Child/children Attends *
ie. David - Betty Shabazz International Charter School
Does your child/children have any dietary restrictions? *
Please provide information on any medication, chronic physical problems and pertinent developmental information and any special accommodations needed. *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent/Guardian Information
Name *

First Name Last Name
Relationship *
Cell Phone Number *

Area Code Phone Number
E-mail *
Best form of contact

Text Email Call
Emergency Information
Relationship
Phone Number *

Area Code Phone Number
Alt. Phone Number

Area Code Phone Number
I individually as a parent/guardian of the child identified above hereby agree to the following:
*

I understand and agree that I will not receive any refund for missed sessions. I confirm that I have fully disclosed to TES any and all conditions (whether physical, mental or behavioural or otherwise) that my child has or may have before my child participates in the program.. I allow my child to be photographed (for marketing purposes) throughout the TES program.
You can pay the registration fee with a credit or debit card by using the checkout below.
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Registration Fee $ 50.00
Fee will be used to purchase materials.

Total $ 0.00
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TES' Academic's STEMAA 2021 Registration Form