Homeschool Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Science Scout RegistrationScience Scout's Name: *FirstLastPlease enter name of child you are enrolling in Science Scout classesDate of Birth: *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Birth: Stripe Allergy/Medical Name of School/Homeschool Co-op:Parent/Guardian InformationParent's Name: *FirstLastEmail: *Phone: *Address: *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeFall Class Offering: *Thursdays 1pm - 2:30pm (Starting Sept. 11, 2025)Date your child is able to start:*Start date for Thursday sessions is Sept. 11, 2025. Please note if your child needs to start in a different week. Emergency ContactName:FirstLastPhone:Allergy/Medical Concerns:Please note any allergies or medical concerns that you would like us to be aware of. Registration Fee: $200 *Pay online (Below)Pay in-person at 1st classStripe Credit CardSubmit