Curious Science & Learning

1Student Information

Student's Name *

Date of Birth *

Gender *

School *

Grade *

2Parent / Guardian & Contact

Parent/Guardian's Name *

Street *

City *

State *

Zip *

Phone *

Cell *

Email *

3Student's Citizenship Status

US Citizen

Green Card

Non-US Citizen

4Program Selection

Term

Summer (July–Aug)

Fall (Sep–Dec)

Spring (Jan–June)

Programs

Note

5Registration Fee

$

6Waiver & Release

I declare that my kid/s will not perform any kind of experiment at home without adult supervision and understand that Curious Science & Learning (CSL) does not encourage any such home activity and is not responsible for any kind of accident or injury. I understand that CSL has the right to cancel or reschedule classes with appropriate notice to the parent/guardian. The registration fee is non-refundable and can be rolled over to the next session if the student cannot attend the current session for a valid reason. I hereby authorize and release CSL to publish photographs and videos of me and/or my minor children for use in CSL's printed documents, website, and training purposes without financial compensation. I release CSL from liability for any claims by me or any third party in connection with my and/or my minor children's participation. I will keep all CSL materials/curriculum confidential and will not disclose them to any third party or competitor.

I have read the waiver & release and agree with the statement. *

7Signature

Name of Parent/Guardian *

Date *

Register Online

Registration Form