Science Club

Registration for Science club:
Club is FULL..you can still register and your child name will be added to a waiting list

* Indicates required field

Child Name *

First

Last

Child Grade *

Child teacher *

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 needs 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 on to the Mad Science website 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