REGISTER FOR CHIRP
Membership Discounts and Purchase Orders
will be applied at the end of the form.
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Email
Parent/Guardian Mobile Phone
See
Themes and Price sheet
for more information
Student Information
First Name
Last Name
Birthdate (mm/dd/yyyy)
Age Group
5-8 year old
9-12 year olds
Please Select Your CHIRP Sessions Fall/Winter Season
November (11/1, 11/8, 11/15, 11/22, 11/29) - Habitats & Ecosystem
s
December (12/6, 12/13, 12/20) - Astronomy & Climate
Fall/Winter Season
$
00
RegField A Fall - Hidden
Please Select Your CHIRP Sessions Spring Season
January (1/10, 1/24, 1/31) - Geography & Geology
February (2/7, 2/14, 2/28) - Botany & Gardening
March (3/7, 3/14, 3/21, 3/28) - Chemistry & Hydrolog
y
April (4/4, 4/11, 4/18, 4/25) - Lifecycles & Development
May (5/2, 5/9, 5/16, 5/23) - Physics & Movement
Spring Season
$
00
RegField A -Spring - Hidden
Program Fee
$
00
Is your family using a Charter School Purchase Order?
Yes
No
Please note: Purchase orders cover the program fee but not the $30 registration fee. Each student using a purchase order will be charged
$30 Per Season
.
Charter School Name
Registration Fee
$
00
Membership
Is your family a current member of GRPC? If Yes,
a 25% Discount will be applied.
YES
NO
If you'd like to purchase membership now, and use the 25% discount, visit
https://grpg.org/ways-to-give/donate/
and choose either Sustaining or Annual Membership.
TOTAL Due today
$
00
I understand my registration is not valid until I complete the family information form and receive a confirmation from a GRPC education team member.
Payment Information
Name on Card
Card Number
MM
YY
Code
Billing Email
Contact Information