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Experiential Ink Pod School Registration
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Student's Name
*
Your answer
Name of Parent or Guardian
*
Your answer
Street Address
*
Your answer
City, Town, or Village
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Contact Phone Number
*
Your answer
Email address
*
Your answer
What school does your student attend?
*
Your answer
What grade is your student in?
*
Your answer
Is there a schedule that your student needs to adhere to? Please list below.
Your answer
Please tell us a bit about your student and family!
Your answer
What days are you interested in having your student attend the Pod School?
*
Monday
Tuesday
Wednesday
Thursday
Friday
Required
What is the best arrival time for your family?
*
Your answer
What time would you want to pick your student up?
*
Your answer
In the event that you are unable to pick up your student, please list the names and phone numbers of 3 people to which Experiential Ink is allowed to release your student. ID's will be checked.
*
Your answer
Will you need financial assistance to attend our program?
Yes
No
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