Mom & Me – STEAMULATION LAB

Email *

Child's First Name *

Child's Last Name *

Child's Date of Birth *

Child's School Grade *

Gender *

What time would you like to register? *

How many people will be participating? *

Please Describe any Food Allergies *

Parent/Guardian's Full Name *

Parent/Guardian's Phone Number *

Address *

Do you want to be notified about upcoming programs?

How did you hear about us?

To secure your booking, please pay $35.

Consent *

Yes, I agree with Stemulation Lab's Terms and Conditions and Refund Policy.

Please do not fill in this field.

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