Curator Club Registration Form 2

1. Child's Name Required

2. Child's Age Required

3. Child's Birthdate Required

Help: MM/DD/YYYY

4. Grade 2023/2024 Required

5. School District/Homeschool Required

6. Street Address Required

7. City Required

8. State

9. Zip Required

10. Email Address Required

11. Name and Phone Number of Parent/Guardian Required

12. Emergency Contact (other than primary parent/guardian) Required

13. Emergency Contact Phone # Required

14. Relationship to Emergency Contact

15. Please check the activity (ies) that your child will be attending

February 10 - Who Done it? March 16 - Predators of the Sky April 6 - Life Cycles July 22-26 - Ecology Camp Before Care for Ecology Camp

16. If Other, please describe where.

17. How did you hear about our program? Check as many as apply