Zip-line Liability Release Form

 

 Upcoming Events

Nov 16:  Super Science Saturday -       Space S.T.E.A.M. (Part 5:  Mathematics)

Dec 21:  Super Science Saturday -             A Dinosaur Christmas

 

 

 

 


Support Akron Fossils! 

 

 

      Fun with science! 

THANK YOU to our donors!     

Click here for a list of 
our generous supporters 

     

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Simply Program Registration 2019-20

Thank you for choosing to study with Akron Fossils & Science Center this school year! 

Please fill out the form below in full to register your child. An initial non-refundable $100 payment for each child is required at the time of registration. Payment plans are available for the remaining sum.

A 10% off mulit-class or sibling discount is available for each child after the first full session registration. If you refer a friend and they register, you will receive $10 off your child's registration. Please note your referrals in the space provided on the form below.

After completing this form, you will be prompted to follow a link to pay your $100 deposit and complete your registration. You MUST pay your deposit or make your payment in full or your child will NOT be registered.

A late fee of $45 will be applied to your student(s)'s balance if registered after September 1. 

Thank you!

 

Student Information
Student(s) and Age(s)
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Grade(s) in School
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Date(s) of Birth
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Address
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Phone --
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Email
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Parent(s) or Guardian(s)
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Emergency Contact
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Please provide the name and phone number of your emergency contact.
Special Care Information
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Please list any allergies, special needs, limitations, or other instructions that we should be aware of in order to provide the best possible care for your child.
Monday Sessions
Monday Upper Level (6th-12th)
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Please check all of the camps in which your child(ren) will be participating
Number of Monday 'Health' participants
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Number of Monday 'History of Medicine' participants
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Number of Monday 'Chemistry' participants
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Number of Monday 'All Day Bundle' participants
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Tuesday Sessions
Tuesday: Lower/Middle Level (K-3rd) (4th-6th)
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Number of Tuesday K-6th 'Earth/Space' participants
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Number of Tuesday K-6th 'World History' participants
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Number of Tuesday K-6th 'Art' participants
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Number of Tuesday K-6th 'All Day Bundle' participants
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Tuesday: Upper Level (6th-12th)
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Number of Tuesday 6-12th 'American History' participants
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Number of Tuesday 6-12th 'Art' participants
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Number of Tuesday 6-12th 'Biology/Apologetics' participants
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Number of Tuesday 6-12th 'All Day Bundle' participants
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Wednesday Sessions
Wednesday: Upper Level (6th-12th)
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Number of Wednesday S.T.E.A.M. participants
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Thursday Sessions
Thursday: Lower/Middle Level (K-3rd) (4th-6th)
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Number of Thursday K-6th 'Matter/Energy' participants
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Number of Thursday K-6th 'Loving Language Arts' participants
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Number of Thursday K-6th 'Entrepreneurship' participants
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Number of Thursday K-6th 'All Day Bundle' participants
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Thursday Upper Level (6th-12th)
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Number of Thursday 6-12th 'American Literature' participants
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Number of Thursday 6-12th 'Entrepreneurship' participants
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Number of Thursday 6-12th 'Physical Science' participants
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Number of Thursday 6-12th 'All Day Bundle' participants
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Referrals
Referral List
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Please list the names of any families you have referred to Simply Classes who have registered for this school year.
Payment
Payment Method
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Parent/Guardian Signature
Text (Multiple Lines)
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I, the undersigned parent/guardian of this minor child, give permission for this child to participate in one of more of Akron Fossils & Science Center's (AFSC) Simply Science, Studies, and/or S.T.E.A.M. program(s). I give permission for my child's picture to be taken to be used in their student journals, on AFSC's website and/or publications or advertisements. I hereby give permission for the adult bearer of this document to create a copy thereof to give consent for emergency medical treatment of my child by a licensed physician.
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