Registration – Private Event

IMPORTANT MESSAGE:

Use the form below only for a RESERVED Private Event (NOT for the Public). Please obtain a Group Code from your class coordinator prior to registering your child. For other facilities, please click here to go to the specific registration form. Please review our Class Schedules prior to registration.

Welcome to our registration page. Please review our policy documents below before you register. Don’t worry, our page is secure.

Child's Name:*

First

Last

Sex:*

Birthdate:*

/

day

month

year

School Name:*

Group Code:*

Grade:*

Parent/Guardian's Name:*

First

Last

Relationship to child:*

E-mail:*

Address:*

Street AddressCityStatePostal / Zip Code

Phone:*

Area Code

-

Phone Number

List known allergies:

Special health need(s)? (We do not administer medication to your child)*

Special health need or accommodation request? (We will try our best but not guaranteed)

Emergency Contact:*

Emergency Contact Phone No:*

Area Code

-

Phone Number

Relationship to Child:*

Waiver form needs to be signed and submitted on the first day of class.*

I understand

I have read the Bionerds Sexual Abuse and Misconduct Prevention Policy and understood the content.*

Yes

I have read the Bionerds Laboratory Rules and Safety Guidelines and agreed to review it with my child.*

Yes

There's no credit or refund for missed class. For charter school parents, I agree to pay the remaining balance if the PO failed to pay the full amount of class fee.*

Yes

Join our mailing list?:*

How did you hear about us?*

We may send home a little "live friend" (such as cricket, ladybug, worms, etc. depending on the topics) with your child during the session. We want to make sure our little friend is welcome and taken care of. Are you okay with that?*

Select Session*

Total Price:

Belong to a Charter School that will fund this program?*

Select your Charter School:*

Security Code: