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Registration for Lego club:
*
Indicates required field
Child Name
*
First
Last
Child Grade
*
2
3
4
5
Child teacher
*
Choose from the list
Atienza
Green
Kaufmann
Pressley
Tinker
Miller
Ritterman
Sambor
Stewart
Whalon
Child's dismissal plan at 3.35pm on the day of the club (bus #, Bowman walker, Rockland walker, MELC, etc)
*
Parent/guardian Name
*
First
Last
Emergency Contact (Name and phone number)
*
Emergency Contact 2 (Name and phone number)
*
Email
*
Phone Number
*
Name(s) of adult(s) authorized to pick up child after club (your child may only leave with an authorized adult)
*
Check here if your child need to return to MELC after club
*
MELC
Name(s) of adult(s) authorized to pick up child after club 2
*
Name(s) of adult(s) authorized to pick up child after club 3
*
In case After School Clubs are cancelled due to weather, how is your child getting home:
*
Car line
Walker
Bus
MELC
All reasonable precautions are taken to assure your child's safety and prevent injuries from occurring. If an incident should occur, you grant permission for the instructor, school or HSA to obtain emergency medical care if it appears necessary.
Agreement to the term
*
"I have read and agree to the terms outlined above."
Comment
*
After you click on the Submit button you will be redirected to Bricks 4 Kidz webpage where you will be able to pay the club fees. If you require financial assistance, please email Anne Heffron at heffroa@lmsd.org as soon as possible.
Submit