​Registration 

Please complete the form to register your child for eSTEAM Club

Select Program*

Select ProgrameSTEAM Summer CampAfterschool ProgramTeen Science CafeSaturday Academy

Parent/ Guardian Information

Parent/Guardian Name

Contact

Address

Child 1 Information

Child Name *

Date of Birth

School Information

Teacher's Name

Authorized person to pickup

Additional Information

Please list if your child has any allergies/ medical conditions

Child 2 Information

Child Name *

Date of Birth

School Information

Teacher's Name

Authorized person to pickup

Additional Information

Please list if your child has any allergies 

Child 3 Information

Child Name *

Date of Birth

School Information

Teacher's Name

Authorized person to pickup

Additional Information

Please list if your child has any allergies 

Additional Contact

Contact Name

Relationship

Phone Number

Sumbit