Join the Afterschool Enrichment Waiting List

We will be in touch when a spot becomes available.

Please feel free to go ahead and sign up for the Spring 2025 session in advance to ensure your child's spot in the program.

Child's First Name

Child's Last Name

Child's Birthday

Month

Day

Year

Child's Gender

Child's Grade

Child's School

Child Lives With

Parent / Guardian First Name

Parent / Guardian Last Name

Home Phone

Cell Phone

Work Phone

Home Address

Approved Pick Up/Emergency Contact List:

I authorize the staff of GEARS Robotics to allow the following persons to pick my child up from school. They may also be contacted in the event of an emergency such as illness or accident. (MUST have AT LEAST one contact listed)

Contact First and Last Name

Contact Phone

Contact 2 First and Last Name

Contact 2 Phone

Contact 3 First and Last Name

Contact 3 Phone

Physician's Name

Physician's Phone

Physician's Address

List of Allergies/Medications or Medical Concerns

Participants must be picked up by you or someone on your approved pick up list, they cannot walk or bike home on their own. Participants must be picked up by the end of each class. It is the parent’s responsibility to notify the Student’s teacher and school of enrollment in this after school class. The parent needs to notify the school and GEARS Robotics of dismissal changes or absences. In the event of cancellation families will be contacted by email AND phone call. Parents must confirm receipt of all communication.

I agree to the Parental Agreement

I agree and have read the terms and conditions

I have read the Parent Guide

Your signature is your agreement that you agree to the terms and conditions listed aboce.