Playful Scholars Academy, LLC Registration Form

Playful Scholars Academy, LLC Registration Form

Please fill out the form below to enroll your child in our activities and complete the payment.
Parent's Full Name*

First NameLast Name
Parent's Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
Scholar's Full Name*

First NameLast Name
Scholar's Age*
Scholar's Birthday*
Please list names, ages, and birthdates of any other scholars that will be attending.
What school does your scholar attend? If homeschooled, type home school.*
Does your scholar have allergies or a medical condition that we should know about?*
Select the Activity*
Step Up for Students - PEPStep Up for Students - UAOnline Payment (Complete Payment and Credit Card information below)
STEP Up For Students Scholarship Payments

1. Complete registration and submit enrollment form.
- Do Not complete the payment box below.
2. Log into your EMA account to choose Playful Scholars Academy, LLC as the provider.

3. Choose the program that matches the activity cost.

4. Prepare for you and/or your scholar to have a great time learning about STEM!

Payment Amount

USDDescription