STEM Escape Race! Afterschool Program Registration

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Student 1
Student 1 Name*
First Last
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Student 1 Date of Birth
MM slash DD slash YYYY
Grade for Student 1*
Gender for Student 1*
- Male
- Female
- Rather not say
Student 1: Is there anything our Brain Chase instructor should know to help keep your child safe and successful during the program? *
- No
- Yes
Please tell us what we should know.*
This might include allergies, medical needs, sensory needs, physical limitations, learning accommodations, behavioral considerations, or other information relevant to your child's participation. Please share only information that our instructor reasonably needs to know.
Product Name*
Select Your Program*
- Sky View Academy| Highlands Ranch, CO | Tuesdays | 4:00pm - 5:00pm | 12 weeks | Starts 9/15/26
+ Get three Adventure Tools with the Explorer package!
+ Get three Adventure Tools, an official Brain Chase Clue Notebook, a program T-shirt, and a Brain Chase Poster with the Adventurer package!
Would you like to add a second student?
- Yes, add Student 2
Total
$0.00

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In which state do you live?
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How did you hear about us?*
Parent Name*
First Last
Parent Email Address*
Enter Email Confirm Email
Parent Phone*
E-Signature*
By typing in your full name, you certify that the information in your registration is accurate and true.
If you have a coupon code, enter it here:
Total
$0.00

Total
$0.00
Credit Card*
Card Details
Cardholder Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Mailing Address is the Same as Billing Address
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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Agreements
- I agree to the Brain Chase Terms of Service and Privacy Policy.
- I have read and agree to the Brain Chase Afterschool Program Terms & Parent Acknowlegment.
Consent*
I have read and agree to the Brain Chase Afterschool Program Terms & Parent Acknowlegment.
Consent*
I agree to the Brain Chase Terms of Service and Privacy Policy.

Student 1