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Summer 2017 STEM Academy Registration
STEM Camp: Code it, Create it, Command it!
Warsaw Campus only, Middle School Students 6-8
June 26-30, 2017
Limited Capacity: 28
Registration ends June 16, 2017 or when capacity is reached
Participant Registration Information
First Name, Last Name
Date of Birth
American Indians/Alaska Native
Choose Not to Specify
Alternate Phone (Cell)/ Daytime Phone
How did you hear about the Summer STEM Academy?
Check all that apply
RCC Facebook page
Middle School's Website
Middle School's Facebook page
Middle School Guidance Counselor
Middle School Newsletter
Middle School Flyer
Word of Mouth
In case an emergency arises, contact:
Name, Relation to Student and Phone: Please provide two
First Name, Last Name/ Relation to Student/ Phone
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This form was created inside of Virginia's Community Colleges.