Registration
Please complete the form to register your child for eSTEAM Club
Select Program*
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
