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Registration Form

Mini Medics at South Tampa Microschool (located at The Prep of South Tampa)

Cost: STM student - $185; Non-STM student - $195

Ages: 3-5 (must be fully potty trained)

Wednesdays, March 27 - May 1 (program dates: 3/37, 4/3, 4/10, 4/17, 4/24, 5/1)

Time: 1:00 PM - 2:00 PM

"*" indicates required fields

Student Information

Student Name*
MM slash DD slash YYYY
Additional Participant/Sibling Information
Full Name
Date of Birth
Emergency Contact(s)*
Full Name
Relationship to Child
Phone Number

Additional Information

Your Name*
The following individuals are authorized to pick up my child:*


Credit Card*
American Express
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Expiration Date

Thank you!

We will be in touch soon with important information about this program. Please be aware, we require a minimum of 6 participants to hold this program. You will receive a full refund in the event we need to cancel. If you have any questions, please contact Kristina at (813) 863-1896 or