STM - 3-4 year olds 3/27 - 5/1 - Little Medical School

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*

First Last

Age*

Date of Birth*

Additional Participant/Sibling Information

Full Name

Date of Birth

Age

Emergency Contact(s)*

Full Name

Relationship to Child

Phone Number

Allergies or Special Medical Considerations

Additional Information

Your Name*

First Last

Relationship to Child*

Phone*

Email*

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

Checkout

Choose your program from the list below:*

Number of participants you are registering for the program:*

Coupon

Total

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

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 kristina@littlemedicalschool.com.