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/
What Fall options would you like to register your children for? *

In Person Meetups Online Classes Monthly STEAM Challenge Robot Check out Program
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.) *
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.)
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.)
Student 4

First Name Last Name
Grade
*PreK/Nursery not available for drop off
Birthday
What would you like us to know about your child? (Special needs, any diagnosis, best teaching practices, interests, etc.)
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 either the $100 in person and/or $50 Online family fee to secure my children’s spaces in co-op via paypal to steamhomeschool@gmail.com once my registration has been confirmed. 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. I understand that all of these fees are non-refundable, with the exception of event cancellations due to Covid-19.
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: *

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

Medical release

Medical Information