School Name:

Child Name:

Age:

Date of Birth:

Grade Level:

Teachers Name:

Parent Name:

Home Address:

Parent Cell:

Work Phone:

Parent Email

A. Full Education Package $165.00 (with tax $186.45)B. LEGO Bricks Program $80.00 (with tax $90.40)C. Robotics Program $95.00 (with tax $107.35)

Please list all medical conditions and any other information we should know:

Opt-out
Opt out for photos/video of students and structures created. The pictures/video will be used to promote the program and will not contain any names whatsoever. The pictures/video will not be distributed to any outside sources and will remain the sole property of Creative Club Global.

Opt-out Opt out to receive monthly newsletter and periodic emails to find out more about camps, birthday parties, holiday programs, events and festivals with Creative Club Global.