STEAM Registration Fall 2019

Student Registration Form STEAM Fall 2019: Tuesdays after school & Thursday evenings

Fill out the form carefully for registration. Hosted at Lutheran Church of the Cross, 3787 Cedar Hill Road, Victoria, BC, V8P 3Z4. STEAM After School begins Tuesday, September 17, 2019, 3:30 to 5:00 PM. Steam Evening begins Thursday, September 26, 2019, 6:30 to 8:00 PM. Arrangement by appointment for early drop off or late pick up for up to 15 min. Your child should bring with them either a laptop or Windows-based tablet if possible to class. Please let us know if you do not have access to a laptop or tablet and we can see what we can do. There is a cap of 20 students per class. Call the church office with questions: 250-477-6222.
Please verify that you are human*
Student Name*

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student E-mail if Applicable
Student Mobile Number if Applicable

Area CodePhone Number
Parent Name*

First NameLast Name
Parent Mobile Number*

Area CodePhone Number
Parent Work Number

Area CodePhone Number
Parent Email*
example@example.com
Courses: Select whether you want to enrol in EITHER Tuesday After School Program OR Thursday Evening Program (you cannot enrol in both)*
Tuition is $25/child for 8 week course. Bring tuition on first day or you may request a tuition waiver.

Will pay by check made out to “Lutheran Church of the Cross”Will pay by cash to Lutheran Church of the Cross officeWill pay by e-transfer: lutheranchurchofthecross@shaw.caRequest Tuition Waiver
Food Allergies, Medical Issues, & Additional Comments
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Student Registration Form STEAM Fall 2019: Tuesdays after school & Thursday evenings