Mix it Up – Winter Break Program- Friday, December 22nd, 2023

$30.00

Mix it Up- Chemistry Craze: Winter Break Program
Friday, December 22nd
Ages 6-14
8 am – 4 pm
at the Kaleidoscope Discovery Center

Don’t forget to fill out the registration form AND pay for the class. You’ll need to “submit” the form below as well as “add to cart”.

Registration Form
Student Name
Student Name
First
Last
Is the student's phone number the same as their legal guardian's?
Student Address
Student Address
City
State
Zip/Postal
Country
Is the student's address the same as their legal guardian's?

Legal Guardian

Legal Guardian Name
Legal Guardian Name
First
Last
Legal Guardian Address
Legal Guardian Address
City
State
Zip/Postal
Besides the legal guardian listed above, is there anyone else you 'd like to list as an emergency contact?ional person listed as well?
Additional Emergency Contact Name
Additional Emergency Contact Name
First
Last

Additional Information

Does your student have any allergies we should be aware of?
List any allergies your child has and please list the reactions to those allergies:
Does your child have an EpiPen?
Is your child able to able to administer the EpiPen themselves?
List any special accommodations needed for your child or anything else you feel is beneficial for us to know. Or feel free to leave blank if there are none.

The Kaleidoscope Discovery Center

PLEASE READ CAREFULLY. THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS.
We may want to use photographs of your child in print or online material designed for news, informational or educational purposes related to The Kaleidoscope Discovery Center. Is this okay with you?

Don't forget to pay.

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