FLL Explorer Course Registration

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Registration

To register, please take the time to fill out the information below.

Parent's Full Name

Child's Full Name

Email

Phone

Child's Birthday

Address

Dates *

Sundays

Mondays

Does your child have any allergies we should be aware of? If so, please describe. If not, please enter No.

Will your child be bringing any medications to the class? If so, please describe. If not, please enter No.

Emergency Contact Name

Emergency Contact Phone Number

Authorized pickup person Name

Authorized pickup person Relationship to the Child

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LOCATION:

5114 Dorsey Hall Drive,
Ellicott City, Maryland

EMAIL:
info@coderpie.com

Contact Us

First name

Last name

Email

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