Sunday Science with John Lyga - November 18 (Grades 2 and up with care giver)

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* 1. Child’s first and last name. Please fill out separate form for each child you are registering.

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* 2. Child's grade? Children must be in grade 2 or higher. All children must be accompanied by an adult.

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* 3. First and last name of Parent or Caregiver accompanying the child

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* 4. Telephone

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* 5. Telephone number of another parent/caregiver for emergencies

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* 6. Does your child have any health-related problems or allergies (food, crayon, glue, etc.) that would limit class participation?

Yes

No

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* 7. If you answered yes, please comment:

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* 8. E-Mail Address (only if you prefer we contact you this way)