2020/21 STEAM registration

2020/2021 Co-op registration
Parent(s) *

First Name Last Name
First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Phone Number

Area Code Phone Number
Alternate Phone number *

Area Code Phone Number
Email *
example@example.com
Email
example@example.com
Emergency Contact

First Name Last Name
Phone Number

Area Code Phone Number
Who has permission to pick up your child? *
Is there anyone who DOES NOT have permission? *
Student Information

Please see our website for our updated parent packet, schedule and fees https://thesteamschool.org/registration/
Student 1 *

First Name Last Name
Birthday
Grade
*PreK/Nursery not available for drop off
What would you like is to know about your child?(Special needs, any diagnosis, best teaching practices, interests, etc.) *
*

Tuesday Wednesday Thursday Tues Sign language (4th-8th) Tues/ Thurs Spanish (4th-8th) Wednesday Lego League (1st-8th)
Student 2

First Name Last Name
Birthday
Grade
*PreK/Nursery not available for drop off
What would you like is to know about your child? (Special needs, any diagnosis, best teaching practices, interests, etc.)
Tuesday Wednesday Thursday Tues Sign language (4th-8th) Tues/Thurs Spanish (4th-8th) Wed. Lego League (1st-8th)
Student 3

First Name Last Name
Birthday
Grade
*PreK/Nursery not available for drop off
What would you like is to know about your child? (Special needs, any diagnosis, best teaching practices, interests, etc.)
Tuesday Wednesday Thursday Tues Sign language (4th-8th) Tues/Thurs Spanish (4th-8th) Wed. Lego League (1st-8th)
Student 4

First Name Last Name
Birthday
Grade
*PreK/Nursery not available for drop off
What would you like us to know about your child? (Special needs, any diagnosis, best teaching practices, interests, etc.)
Tuesday Wednesday Thursday Tues Sign language (4th-8th) Tues/Thurs Spanish (4th-8th) Wed. Lego League (1st-8th)
Fee Agreement
I would like to be considered as a LEAD teacher in...
Days and classes you'd like to teach
I would like to stay and assist on these days...
Days and grades you volunteer to assist
I will pay drop off fees for these days
Days you'd like to drop off
My monthly fees will be... *
I would like to pay (for drop off only)

monthly Annually (5% discount)
I understand that I must pay the $55 and $155 registration family fee to secure my children’s spaces in co-op via paypal to steamhomeschool@gmail.com to complete my registration. I must also pay the second semester family fee by January 15th of that year to ensure my children’s space for the spring semester. If I have elected to drop off, I agree to pay those fees by the 15th of each month. I understand that all of these fees are non-refundable.
I agree to this by typing my name below. *

Photo Release
Type a question *

I grant to the STEAM school, its representatives and volunteers the right to take photographs of me and my children during STEAM co-op time or STEAM events. I authorize the STEAM school to use and publish the photos in print and/or electronically. I do not grant permission for photos to be taken of my child I grant permission for photos to be taken of my child for use on our internal parent app, Bloomz, only
I grant permission for my child to be used in publication under the following conditions...
I agree to this photo release by typing my name: *

Parent proxy and medical release
I designate the following person to serve as a parent proxy in my absence, (Either a friend, or our coordinator, Lyndsey Pheister. For Drop off parents only.)
By signing this form, I hereby waive the STEAM School, its officers and members, from any liability of injury and loss or damage of personal property associated with participating in this event. I understand that my children are under the care of a parent proxy, not the STEAM School. By typing my name below, I acknowledge that I understand this waiver.
Name and date *
Medical Information
Pediatrician *
Phone Number *

Area Code Phone Number
Allergies or other medical conditions *
Insurance Information (name, provider, group#, policy#) *
Should be Empty:

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2020/2021 Co-op registration

Student Information

Fee Agreement

Photo Release

Parent proxy and medical release

Medical Information