New Makers Registration Form | MINIMAKERS - Dream, Build, Create, Inspire

Legal Guardian #1 - Name *

First

Last

What Program are you registering for?

What location are you registering for? *

Your Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Legal Guardian #1 Phone - Mobile *

Legal Guardian #2 - Name

First

Last

If applicable - only one legal guardian name required.

Legal Guardian #2 Phone - Mobile

If applicable - only one legal guardian phone required.

Makers Name *

First

Last

Makers Grade *

Makers Date of Birth *

Our curriculum developers have designed lessons for kids 5-12.

Any Allergies / Medical Conditions / Special Requests or Needs *

Which subjects does your little maker enjoy the most? (check all that apply) *

Maker's Goals

Please describe both yours and your little makers goals for the MiniMakers program.

Emergency Contact #1 *

First

Last

Must be different than legal guardian

Emergency Contact #1 - Mobile Phone *

Emergency Contact #1 - Relationship to Maker *

Emergency Contact #2 *

First

Last

Emergency Contact #2 - Mobile Phone *

Emergency Contact #2 - Relationship to Maker *

How did you hear about us?

Please specify (if referred, please provide the name of the referral as we wish to thank them)