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Please use this form to register for our
Astronomy Mini-Camps, for grades 3 -7.
Please call us at 716-434-3196 if you have any questions. Thank you!

Preregistration is required. $10 per session is payable at the door in cash or check made out to "CLC of ONE."
Please stay tuned for our next class schedule!

* Indicates required field

Parent/Guardian Name *

First

Last

Parent/Guardian Cell Number *

Home Phone Number *

Email *

2nd Parent/Guardian Name *

First

Last

2nd Parent/Guardian Cell Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Child 1 Name *

First

Last

Child 1 - Age *

Child 1 - DOB *

Child 1 - Comments/Allergies/Medical Conditions *

Child 2 Name *

First

Last

Child 2 - Age *

Child 2 - DOB *

Child 2 - Comments/Allergies/Medical Conditions *

Child 3 Name *

First

Last

Child 3 - Age *

Child 3 - DOB *

Child 3 - Comments/Allergies/Medical Conditions *

Child 4 Name *

First

Last

Child 4 - Age *

Child 4 - DOB *

Child 4 - Comments/Allergies/Medical Conditions *

Communications options *

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Please use this form to register for our
Astronomy Mini-Camps, for grades 3 -7.
Please call us at 716-434-3196 if you have any questions. Thank you!

Physical Address

Mailing Address

Phone

Please use this form to register for our ​Astronomy Mini-Camps, for grades 3 -7. Please call us at 716-434-3196 if you have any questions. Thank you!

Physical Address

Mailing Address

Phone

Please use this form to register for our
Astronomy Mini-Camps, for grades 3 -7.
Please call us at 716-434-3196 if you have any questions. Thank you!