Multi Program Signup Form

Please select your choices for Meemli Programs and submit this form.

We will reply with more details and request you to confirm your choice before enrolling your child in the selected program.

The program is free, but please make sure your child can commit to attending the program as space is limited and there will be other students who are eager to attend.

Thanks for your interest!

Note: We request you provide your phone number so we can call or text you regarding the programs. By calling or texting Meemli at 888-248-9904, you agree to receive messages. If you no longer wish to receive text messages, you may opt out at any time by replying “STOP”.

Parent’s email address *

Re-enter Parent’s email *

Parent’s name *

Phone Number To Contact

Child’s name *

Child’s grade *

Child’s school *

City *

State *

Phone Number To Contact

Select all programs your child would like to join *(required)

Hands-on Science

Math Word Problems

Reading Comprehension

Additional details/comments/questions/requests