Mad Science of Denver
7100 W. Grandview Ave., #5
Arvada, CO  80002
303-403-0432
Fax: 303-403-0343 

Hands-on Science Class Registration

 

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Please provide the following information. You will receive an e-mail confirmation of the receipt of this form.

* Required Fields: 
* School:  
* Class Code:  
* Class Day:  
* Start Date:  
* Start Time:  
* Child's Name:  
* Birthday:  
* Grade/Teacher:  
Health concerns:  
* After class my child will:   Attend Daycare at the School 
Walk Home
 Be Picked-up by 

 Contact Number for this person
* Parent Name:  
* E-mail :  
* Daytime  Phone:  
* Evening Phone:  
Cell Phone:  
* Street Address:  
* City:    * State:  * Zip: 

Please see the form sent home for specific details of your school.  Actual amount charged to your credit card will be the amount indicated on the information form distributed by your school.  If you have any questions call 303-403-0432 prior to submitting this form.

* Credit Card Type:   
* Credit Card Number(1):  :
* Name on Card:  
Billing Address:  
(If different then above):  
* Expiration Date:  

By providing this information you authorize Mad Science of Denver to charge your credit card in the amount indicated above.  You give permission for your child to attend the Mad Science class and acknowledge that you have read and understand the cancellation and refund policies for the Mad Science of Denver Enrichment program.  

(1) Please note: This e-mail method of registration will require you to provide credit card information.  This information will be e-mailed to Mad Science of Denver's registration desk.  This method does not use secure connection technology.  While Mad Science of Denver will take precautions to safeguard this information we can not be responsible for unauthorized access of this data by non-Mad Science of Denver employees.  If you are uncomfortable with this registration method, please write "Call In" in the credit card number field and call our offices at 303-403-0432 Monday – Friday, 9am – 4:30pm to provide your credit card number.

Copyright © 2004 Mad Science of Denver.   All rights reserved.
Revised: September 18, 2007