Physical Computing 101 SP20 Registration
Thanks for your interest in Physical Computing 101! AT THIS TIME THE CLASS IS FULL!! If you would like to receive notices of future programs, please subscribe to our monthly newsletter @  https://www.techchangers.org/contact-us.html   When signing up, make sure you check your email and click on the confirmation to confirm you are in:)
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Child's First Name *
Child's Last Name *
Primary Address *
Grade *
Required
School Name *
Primary Parent/Caregiver First and Last Name *
Primary Cell Phone *
Primary Home Phone
Primary Email Address *
Emergency Pick Up First and Last Name *
Emergency Pick-Up Relationship (relationship between child and emergency pick-up.) *
Emergency Pick-Up Cell Phone *
Does your child have any limitations or medical conditions that could affect their participation in this class? *
Please explain if you answered yes above. Be sure to include asthma and allergy information.
Acceptance of Waiver and Hold Harmless Agreement* I accept the Waiver and Hold Harmless Agreement. View form at:      http://bit.ly/2kIFxUS *
Late Pick Up Policy*  Please read and accept our Late Pick Up Policy: Thank you in advance for ensuring that your child is picked up on time. In the event of excessive wait time for pick up, the following policies will apply: After one late pick up of 15 minutes or more, there is a $5.00 fee for the first 15 minutes, and $10 fee for the second 15 minutes and each succeeding 15-minute time segments. After 45 minutes, we will reach out to the emergency contacts to request pickup. After two late pick-ups of 15 minutes, we will contact you to discuss terminating your child's participation in the course. *
DEMOGRAPHICS:  One of our goals is to ensure we are providing programming to a diverse group of girls and boys.     Please indicate your ethnicity: *
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