Build & Code 4 Sessions (Palmer)

3 out of 6 filled

Mondays Oct. 26th - Nov. 16th 4:30 - 6:00 pm $170 Family Christian Center

Student's First Name*

Student's Last Name*

Parent/Guardian's First Name*

Parent/Guardian's Last Name*

Primary Email for Class Information*

Primary Phone Number*

Secondary Email for Class Information (Optional)

Secondary Phone Number (Optional)

Method of payment for class fees (invoice/forms to be emailed after review)*

Invoice to be paid upon receiptDirect bill homeschool program

Homeschool program & advisor name, if applicable

Student Grade Level*

Student's Birthday

Can we take pictures for use on social media?*

YesNo

Any food allergies?

Anything you'd like us to know to help improve your student's experience at class?

Emergency Contact & Phone Number

Liability Policy *

My student's participation with Bricks Kids N Gears LLC classes are voluntary. I understand that the selected activities may involve accidental injury and voluntarily assume such risks. I (on the behalf of my student) release Bricks Kids N Gears LLC, its employees and community center site where said classes will take place, for any claims for damages for personal injuries.

I agree