REGISTER Montclaire

Registration for Montclaire Elementary Winter/Spring semester 2020
Please complete the form below and click the continue button to register .
Schedule information :

Grades : 1st , 2nd and 3rd Grade
Location: The Art Room
Price: $336.00 for 14 classes
Day and Time: Wednesdays , 2:45pm - 4:00 pm
Duration: 01/22/2020 to 05/20/2020
Dates: 01/22 01/29, 02/05, 02/12, 02/26, 03/04, 03/11, 03/18 , 03/25, 04/01, 04/22, 04/29, 05/13, 05/20

Students walk over to the classroom where supervision is provided till the class starts . Please advice your child to head straight to the room to avoid any delays in starting the class.
Our educator checks-in all students using an online sheet which parents can view to verify the presence of their child in class.

Registration Form

* Indicates required field

Child's name *

First

Last

Child's Grade *

Child's Gender *

School name *

Primary contact name *

First

Last

Relationship with child *

Gender *

Authorized to pickup child *

Yes

Primary email address *

Primary phone Number *

Secondary contact name *

First

Last

Relationship with child *

Gender *

Authorized to pickup child *

Yes

Secondary email address *

Secondary Phone Number *

Medical Information ( list any allergies or medications that the child has or write NA) *

Liability Release
I, the undersigned, in consideration of participation in the Programs / classes offered by "Petri-dish Science " , I agree to indemnify and release the Petri-dish Science Program , its officers, staff, employees , independent contractors , volunteers and vendors , from any and all liabilities from any injuries which may be suffered by the above named child, arising out of, or in any way connected with participation in the classes or activities offered by the Petri-Dish Science program. I acknowledge that I have read the above agreement and release, and fully understand that I have assumed all the risks of injury that may occur in the activities offered by the program. I hereby further authorize the Petri-dish Science Program as the agent for the above named child to consent to any medical diagnosis or treatment and hospital care rendered by and under the general supervision and advice of a licensed physician or surgeon in case of accident or illness during a session of any classes , camps or activities offered by the Petri-dish Science program.

Terms and conditions *

I have read the above terms and conditions and agree

Name *

First

Last

Image/Video Permission *

I grant permission to post images/videos of my child on the Petri-Dish Science Website as part of semester end program highlights .

Submit and Continue

​Registration for Montclaire Elementary Winter/Spring semester 2020Please complete the form below and click the continue button to register .Schedule information :

Registration Form

Contact Us

Registration for Montclaire Elementary Winter/Spring semester 2020
Please complete the form below and click the continue button to register .
Schedule information :