Wufoo
Deilab Enrollment Form
Please select which of our camps or after school programs you would like to enroll in and provide the information requested below.
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Warren-Prescott School Grades K1ED, KED, FED, and SED 9/27/18-12/20/18 Lego
Warren-Prescott School Grades SED, 3AS, 4AS, 5AS, 6AS 9/27/18-12/20/18 Robotics
DEWITT-Sat. November 3, 2018
DEWITT-Sat. November 10, 2018
Warren-Prescott School Grades K1ED, KED, FED, and SED 9/27/18 - 12/20/18 Lego Engineering. No Class 11/22/18
This program will run from 9/27/18 - 12/20/18 on Thursdays after school from 5:00 to 5:50 PM. There will be no class on 11/22/18.
Warren-Prescott School Grades SED, 3AS, 4AS, 5AS, and 6AS 9/27/18-12/20/18 Robotics
This program will run from 9/27/18 - 12/20/18 on Thursdays after school from 5:00 to 5:50 PM. There will be no class on 11/22/18.
Participant's Name
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Date of Birth
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Pre-Kindergarten
Kindergarten
First Grade
Second Grade
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Fourth Grade
Fifth Grade
Teacher's Name
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Please list any other medical conditions we should be aware of
Emergency Contact Information
Parent 1 Name
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Last
Best Phone Number
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Alternate Phone Number
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Email
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Parent 2 Name
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Parent 2 Phone Number
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Please provide names and contact information for any other individuals you authorize to pick up your child in case of emergency (i.e. babysitter, grandparent, older sibling, etc.)
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I hereby authorize Deilab to contact any and all of the individuals listed above in the event of an emergency concerning my child.
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