TEKI Winter 2021 (Session 2) Registration
Thank you for your interest in our Winter TEKI Program.  Please answer these question in order for us to have the correct information for your child.  If you have any questions please contact me at 917-940-4711 or hweinrib@theteki.com
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Email *
Participants Name *
Current Grade *
Required
Current School *
Address *
Parents Name *
Parents Phone Number *
Additional Parents Name (if applicable)
Additional Parents Phone Number (if applicable)
Additional Email Address (if applicable)
Enrichment Location: *
Required
Are you interested in Virtual or Live Enrichments
Clear selection
Are you signing up for a Public or Private Group Enrichments?
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If this is a Private Group, please list the date(s) and time(s) you are looking to start.
Virtual Weeks Interested In?
TEKI Florham Park Sports Dome Enrichments Interested In (If Applicable)?
What level would you say your child is at currently?  
Do you have access to a computer and or a Tablet?
Clear selection
If you answered yes above, what device do you have?
If you answered No above, would you want to borrow a sanitized device from TEKI?
Clear selection
Does your child have access to wifi? *
Please list your child’s allergies if necessary. *
Any other concerns for your child?
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