Fall into Science & Art Registration Form: ENGAGE IN SCIENCE THROUGH THE ARTS!!!

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Hands On Interactive Science FUN!
Learn Why and How Leaves Change Color- Teaching through Dance & Movement (STEAM)
Plus a CREATE and TAKE Craft (Makes a nice personalized Christmas gift for family or friends!!)
K-5th Grades (dress in comfortable, loose fitting clothes you don't mind getting soiled so your kids can enjoy the dancing and art/painting)

The Emerge Center (Located at The River Church)
4900 Prospectus Drive
Durham, North Carolina 27713
Sat. Nov 23, 2019
10:00am-12:30pm

**Please complete a registration form for each child attending the workshop. Once completed, submit payment via the PayPal link on the website ** Thank you!

Email *

First Name (Child) *

Last Name (Child) *

Gender of Child *

Age/Current Grade in School *

List any Special Needs (Allergies, Disabilities etc.) *

First Name (Parent) *

Last Name (Parent) *

Address

State/Province

Zip/Postal

Home Phone *

Cell Phone *

Emergency Contact (First Name) *

Emergency Contact (Last Name) *

Emergency Contact (Phone) *

Share your child's favorite songs/music! We can incorporate your child's favorite music within this learning experience. List 1-2 songs your child enjoys:

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