MAD SCIENCE” ENRICHMENT) PR REGISTRATION FORM IT'S ALL ABOUT THE SCIENCE! PLANETS & MOONS: plore our slo: tysem inthis “mad planetary {ear andar now the plants ace up, Lavine m seace ‘perience the feof 9 astronaut as you su up for ‘ce Tight Make a Cosmic Cwonometer match to ‘mare the tie ere on Earth ARNESSING HEAT igen the properties o heat witness an underwater \eeano, exoarment wth thermometers and Mave 8 “Sond siot™ plore excisng physi and chemal reactions at Yeu make "goo" out of foam ond make olf ond eter mo ss won Esjoy ths whining clase on hom 3 ab works! Take a OL wn ecoaaely Fare your very own gear to cminue Your rere ‘8 Week Program, Oct. 5 - Nov. 30, 2010 Coat/t208: 00 jper stadent igre, esters Ler te scence senna Registration Deadline: Tue. Sep. 28, 2010 (Til ck You ton recreate or Youre 8 oer, To register after the deadline call: Mad Science of Los Angeles eM INAFLASH oie 20926272. cence expeince! Plt op an Acton Pk and wen madscenee orgosangles Fey Please see Registration Details on back Fron sip ua ue No 23, 2010 $5 to cong ait amity. over School: Kentwood Elem {ss Dey: Tuesday, 1135 «2138 pam, Dates: October 5 - November 30, 2010, Grades: 1-5 ‘8 Weak rogrom Cost $106.00 par student, Case Cos: KWDOLO hits Name: irtnday ae Lee) nen) Grade/Teacher:( Address: ee ee) a ‘Sreet ‘ity State zp ty Cn wa © nerd Day Care ate Schoo! © Wak ame_O Be Picken by) Pe: eae ist any heat concerns: = sa. coe Return Check and Form to: Payment ©) Checks Make check payable to "Mad Science of Loe Angeles". Method: OViea/MC g ‘ame on Coed "Number Parent email [ parent's signature >> | (All Class Confirmations willbe made by Emall)Mail this form to Mad Science of Los Angeles! 8107 Orion Ave. Van Nuys, CA 91406 Pay the Early Bird Registration Fee of $108 by Tuesday, September 28, 2010 Please make checks payable to Mad Science of Los Angeles ‘Aminimum of 12 students registered by 9/28/10 is needed to run the Mad Science program. Registration Details: ‘Register Dy mailing registration and Early Bid registration fee to Mad Science of Los Angeles before the ‘enaline Usted above. *+ Register by phone with a MasterCard/Visa by calling (818) 909-6777. An additional $5 administrative fee willbe added to the cass price for phone registrations. + Register by faxing your registration form with credit ‘ara information to (818) 909-6771 + Register by emalling a scanned copy of your For future Mad Science DISCOUNTS, rear fom, ong with your re card deta, please join our mailing list at + ATO ate fee willbe added :o any registrations made Bclence.org/toskngeles ‘after the deadine listed above. Follow us an Twitter + Dectined credit cards and NSF checks willbe charged a ff www. Twitter.com/ LA S40 handing fee. How bis are the classes? ‘Mebelee fealty ser elo! Claes ll have 124 cadet What my child misses a session? Io bur can op We epee ooo ter. yer cM mela, wl eet he Progen the Ar Shoal Pogan There Attendance ‘naar the repens ofthe parent Rese wr te date of he aes an ur calender and rem orci tend lt ar ‘ht ot lena ogo and Wom ha cence, lense one ington em tne yor oxen Rnergutn a What fs Mad Science? “Hat Snes fsx Fog conducts evento, eter an hanon cence activites fr preset and elamenary age chen, Our orach' imple- We tbe meng atti ad Wecarardemarstiaers to ape ihe aenton sod warratan of Shore. ice ‘tated by he satin, we fac res of wean epee hwy he charen can paricpte Our programs ae east SRSPUNG We saya fe maar cqupmen ad the ue th Chae mane tees vey of ace es Te oy ore rol efi ha Sere ww mat rb edn 8 yoo Prewrans tne costars for movement, Wer atending he Cay your Nd Go aw caus nad scence, scat ‘Ste lr athe scan scheled ci swe wu yous eu es aS poe Ws) Ate a he, enw ea. “iretuns take 4-6 weeks to paces, ur calendar - Confirmations wa canceled check or Credit Card Statement i i ‘Completing the registration form enrolls your child in the Mad Science program. You agree to release ‘the School and the School District from all lability. You also agree that your child will adhere to the classroom policies established atthe first meeting. PLEASE KEEP THE TOP PORTION OF THIS FORM FOR YOUR RECORDS