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Contact Us

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32127 Temecula Pkwy SUITE F, Temecula, CA 92592
(951) 530-3396
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Temecula STEAM Club

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Student Application

# of Children

1 child 2 children 3 children None

First Name *

Last Name *

Phone *

Birthday *

Gender *

Second Child

First Name *

Last Name *

Phone *

Birthday *

Gender *

Third Child

First Name *

Last Name *

Phone *

Birthday *

Gender *

Parent or Guardians Information

First Name *

Last Name *

Email Address *

Address *

City *

Desired Start Date *

Phone 1*

Phone 2 (optional)

Emergency Contacts

First Name *

Last Name *

Email Address *

Phone *

How did you hear about us? *

Relationship to the student *

Medical Information

Does this student have? Allergy *

Yes No None

Special Needs

Yes No None

Dietary Restrictions

Yes No None

Physical Restrictions

Yes No None

Notes

Time's up

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After-School Program in Temecula

Get exclusive offers and the latest information sent directly to you

Student Application

# of Children

1 child 2 children 3 children None

First Name *

Last Name *

Phone *

Birthday *

Gender *

Second Child

First Name *

Last Name *

Phone *

Birthday *

Gender *

Third Child

First Name *

Last Name *

Phone *

Birthday *

Gender *

Parent or Guardians Information

First Name *

Last Name *

Email Address *

Address *

City *

Desired Start Date *

Phone 1*

Phone 2 (optional)

Emergency Contacts

First Name *

Last Name *

Email Address *

Phone *

How did you hear about us? *

Relationship to the student *

Medical Information

Does this student have? Allergy *

Yes No None

Special Needs

Yes No None

Dietary Restrictions

Yes No None

Physical Restrictions

Yes No None

Notes

Time's up