Sparking Imaginative Learning

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Home > What We Do > After-School Programs > Program Request Form >

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Program Request Form

Please use this form to indicate your program preferences. Once we receive your request, we will contact you to confirm.

Click here to register your child for a current program.

Contact Mad Science for more information at mail@madsciencesd.com or call (858) 300-2481.

Customer Information

School or Organization
Address
Contact Name
Position

Contact InformationIt is important that we are able to contact you if we have any questions. Please provide a phone number where you can be reached. Your email address will be used to send you a confirmation letter.

Day Phone
Cell Phone
Email

After School Program Information:

Day of the Week:
School Dismissal Time:
# of Weeks:
Requested Start Date:
Additional Information

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