Orpheum Learning Pod
If you do not receive an email within 1 business day confirming you have reserved a spot in a Pod or that there are not enough places for your student, please email education@orpheumkids.com.
Sign in to Google to save your progress. Learn more
Email *
Student's Name
Student's Date of Birth
MM
/
DD
/
YYYY
Student's Grade
Parent/Guardian Name
Mailing Address
Contact Phone Number
Emergency Contact Name (should not be same as contact)
Emergency Contact Number
Any Known Allergies?
Which weeks would you like to enroll in?
POD details
Since all schools may have slightly different schedules it is important for us to know some information to best meet the needs of all members. Questions that ask for needs should address the latest and earliest times you would be able to arrive and pick up. We will likely extend beyond the pods needs to better meet any desired time frames.
Needed Start Time for Pod
Time
:
Needed End Time for Pod
Time
:
Desired Start Time
Time
:
Desired End Time
Time
:
What time is your students scheduled classes?
Will you need any technology provided? (computers, webcam, etc)
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Orpheum Children's Science Museum. Report Abuse
Google Forms