Yazi STEAM after school Registration

Yazi STEAM after-school program

Student Name*

School*

Grade Level*

Gender*:

Male

Female

Birth Date*

Mailing Address*

Desired dates of session*:

Weekdays (after school)

Weekends (Saturday mornings)

Summer

Fall

Parent/Guardian Information (Emergency Contact)*

Parent/Guardian1 Name*

Work Phone*

Cell Phone*

Email*

Parent/Guardian2 Name

Work Phone

Cell Phone

Persons to whom child may be released:

Person 1*

Person 2

Person 3

Person 4

How did find out about us (please select all that apply)

Newsletter

Website

Another Parent

My School

Friend

Social Media

Other

I confirm that all information entered here are correct

Choose a payment Option

Yazi Office (Edwa Close, Abelemkpe)

Mobile Money/Card

Other

Call/Whatsapp us anytime on +233 (0) 596 167 976 or +233 (0) 302-789-621