STEAM Studio Parent's Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Number of Children Attending*Name of Child 1*Birthdate of Child 1* Date Format: MM slash DD slash YYYY School Child 1 Attends*Name of Child 2Birthdate of Child 2 Date Format: MM slash DD slash YYYY School Child 2 AttendsName of Child 3Birthdate of Child 3 Date Format: MM slash DD slash YYYY School Child 3 AttendsIs this the first time you have attended an event at Mirowitz?* Yes No How did you hear about Mirowitz STEAM Studio?* Postcard in the mail Postcard from pre-school Facebook Instagram A friend Email The Jewish Light Other (explain below) Explain here:Are you interested in learning more about Mirowitz?*Yes!No, thanks.Are you interested in learning more about PJ Library?*Yes!I already receive PJ Library books!No thanks!
