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Hyalite 2021 STEAM Club Registration
Use this form to register your 3rd Grader for after school STEAM Club!
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* Indicates required question
Student Name
*
Your answer
Classroom Teacher
*
Hirsch
Conwell
Which session are you signing up for?
*
Thursdays, April 29 & May 6, 3:15-5:15pm
Mondays, May 10 & 17, 3:15-5:15pm
Parent/Adult #1 Name
*
Your answer
Parent/Adult #1 Phone
*
Your answer
Parent/Adult #1 Email
*
Your answer
Parent/Adult #2 Name
Your answer
Parent/Adult #2 Phone
Your answer
Parent/Adult #2 Email
Your answer
Emergency Contact Name
*
Your answer
Emergency Contact Phone
*
Your answer
Unless otherwise communicated, upon dismissal of the club my child will:
*
Be picked up
Walk home on their own
Other:
We will be providing a snack during STEAM Club. Please let us know below if your child has any food allergies.
Your answer
If we take photos of the kids hard at work in STEAM Club, we may want to share them on the PAC Facebook Page, Hyalite School Website, or in MOSS website/materials. Do we have your permission to share these photos of your child?
*
Yes
No
Required
Is there anything you want to share with the MOSS instructors about your child that would help with behavior, learning, participation, etc?
Your answer
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