Student Name *

First Name

Last Name

Parent Name *

First Name

Last Name

Current Grade

2nd

3rd

4th

5th

6th

We are interested in STEM for Spring 2024 *

Yes

No

We have participated in After-School STEM with Mr Bob Previously *

Yes

No

We are available

Check all that apply

Saturday Morning

Saturday Afternoon

Friday Afternoon

Thursday Afternoon

Weekday evenings