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After School Program request

If Mad Science programs are NOT offered at your child's school, you can help change that.

Complete the form below and submit it. We will attempt to set up a program at your school.  

Your Name:
Home Number:
Cell/Alt. Number:
Student(s) Name:
School Name
Street Address
School Principal's name:
Another Contact:
Contact's Position:
Contact's Phone:
Which Mad Science program would you like to see offered at your child's school?
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