Homeschool Lab Registration
Parent First Name*
Parent Last Name*
Today's Date*
City, State, Zip*
Primary Phone*
Whose number is this*
Is this a cell, personal or business phone?* Cell
Email Address*
Edgerton Member?* Yes

Please list First & Last Name and Grade for child(ren) attending...

Child Attending Name
Additional Child Name
Additional Child Name
Additional Child Name
Additional Child Name

I would like to register for these dates and sessions...

In an effort to reduce waste, only a few extras of each session's supplies will be purchased. Those supplies will go first to registered participants, and then on a first-come first-served basis to walk-ins. In line with this, because of limited space, do make sure to pay attention to which session you are signing up for, or contact us with questions.

Sept. 15th - Prairie Plants & Seed Collection
Oct. 27th - Light (Laser Show)
Nov. 17th - Cooking and Nutrition
Dec. 8th - Simple Machines
Jan. 12th - Art in Science
Feb. 2nd - Electricity (CLOSED)
Mar. 9th - Reptiles (CLOSED)
April 6th - The Sun

Any medical or special conditions we need to be aware of to give best possible service to your child/children?
(If you have multiple children attending please list child's name with condition)

Parent Liability Waiver

I, the undersigned parent or guardian of the child named above does hereby consent his or her participation in the Edgerton Explorit Center Afterschool Program. I acknowledge that participation in the program may expose the above named student/students to possible injury. I agree to waive and release the Edgerton Explorit Center from all claims of damages that may arise. I authorize the Edgerton Explorit Center and other organizations affiliated with their Afterschool Program to use photographs of my child on Facebook, their website, promotional brochures and at the center.

I also give permission to transport or walk my child to special events and field trips off site during the Afterschool Program. I acknowledge that my child/children is expected to behave in an appropriate and respectful manner and participate in all activities. If inappropriate behavior issues are consistent, your child will be asked to take a break from the program until the problems have been addressed, corrected and resolved.
* I understand and agree
Confirmation Code:
Enter the code shown in the box before clicking on submit.

Note: Fields marked by an asterisk (*) are required.

If you can’t submit this registration online, contact Mary Molliconi at 402-694-4032. Once your registration is processed, we will contact you about the program. For more information, please contact Mary Molliconi at 402-694-4032 or

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