Parents Night Registration

Online Registration Form

Please note that registration forms do not guarantee your child a spot in the sessions, payment does.

Child's Name *

First

Last

Program *

Age *

Parent's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Main Family Phone *

Parent's Cell Phone *

Email *

Emergency Contact #1 *

First

Last

Emergency Contact #1 Phone Number *

Emergency Contact #2 *

First

Last

Emergency Contact #2 Phone Number *

Program Options *

September 8: Inventor's Workshop November 10: Rockin' Robots January 12: Wacky Science March 9: Backyard Biology May 11: Treasures of the Earth

People authorized to pick up my child (List all names) *

Medical Information: Are there special accomodations needed due to allergies, medical or physical limitations, disability, dietary constraints or other restrictions? *

No Yes

If you answered yes, please list them here *

How did you hear about this program? *

If you answered other, please explain here *

The cost of the program is $15 per session. Payment must be sent in following your registration form and will not be accepted the night of your program. Registration forms do not guarantee you a spot, payment does.

By clicking the “submit” button below, I attest that I am legally responsible to give permission to the student named above to participate in the activities of the programs for which they have applied. I give permission to Sturgeon City of Jacksonville, NC and its partners to release and to allow photography and identification (including first name, age and school) of my minor child for publicity, news coverage, promotional presentations and web presentations of its programs as needed. I understand that those associated with the camp will not share the birth date or other personal information except to medical personnel or as required by law. I give permission to camp staff to take reasonable actions should my child be injured or need treatment while making efforts to contact me or the persons named above for further guidance. I accept the responsibility of retrieving my child at any hour and at any place if my child becomes a discipline problem or disruptive to the program or other students.

A Sturgeon City employee will contact you once your registration form is received.

Submit

Payment Methods

You are required to pay in advance. Your registration form does not guarantee a spot in these sessions. To be guaranteed a spot please pay for each session you will be attending or for the annual pass. If you have questions about payment please contact the Program Coordinator at (910) 938-5079 or programming@sturgeoncity.org.

A Sturgeon City employee will contact you once your payment is received.

**If you are paying for more than one Street Science enrollment, update your quantity on the paypal page for each additional child. For questions about payment contact the Program Coordinator at (910) 938-5079.

Note: You do NOT need a paypal account to process an online payment. Choose the "check out" option; this will take deliver you to the order summary page. Once there, select the link "Don't Have a Paypal Account?".