Studio 10;15- Summer Makers Space Experience

Studio 10;15 Registration Form
Makers' Information
Child's Name

First NameLast Name
Age
Gender

MaleFemale
Will a sibling be attending
Your Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How will your child be getting home?
Complete section below for bus/pick-up
Parent/Guardian Information
Parent/ Guardian Name

First NameLast Name
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Parent/ Guardian Name

First NameLast Name
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information

someone who is not parent/guardian that can be contact if you are unavailable.
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Does your caker have any allergies, chronic illness, or medical conditions? If yes, please describe. Because we will there will be nature walks and contact with natural herbs, we also need to know if your maker has allergies to certain plants or trees as well.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and ALL activities prepared by Stuido 10;15 during the selected week(s). This includes on campus and off-campus activites.

In exchange for the acceptance of said child’s candidacy by Studio 10;15, I assume all risk and hazard incidental of all activities, and release, absolve and hold harmless Studio 10;15 and all its respective representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected sessions.
Date

MonthDayYear
Date
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature

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If your maker will catch the bus after club, What bus would you like them to catch?
If your maker is being picked up, who will collect them?

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Payment - IMPORTANT

We can’t wait to start creating with your maker! Please keep in mind that because space is limited each week, all registrations are final and non-refundable. By signing up, you’re securing a dedicated spot in the club, so we are unable to offer cancellations.

Week One July 6 - 10

Foundations & Flexibility

Focus: Mastering the tools and defining the Maker Mindset.

$285.00 Quantity
Item subtotal:$0.00

Week Two July 13 - 17th

Collaboration & Connection

Focus: Working in teams and designing for the environment.

$285.00 Quantity
Item subtotal:$0.00

Week Three July 20 - 24

Mastery & Innovation

Focus: Independent projects and community impact.

$285.00 Quantity

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

Studio 10;15 Registration Form

Makers' Information

Page 2

Payment - IMPORTANT