M.A.S.T. Summer Camp 2019 Registration
(Manufacturing Academy of Science & Technology)
Applying For: *
Student Name: (Last, First) *
Mailing Address, City, State, Zip: *
Grade Entering 19-20 School Year: *
School District: *
County of Residence: *
Parent/Guardian Name: *
Home Phone # *
Parent Cell Phone #
Work Phone #
Emergency Contact if Parent/Guardian cannot be reached: *
Emergency Contact Phone #: *
Can anyone other than Parent/Guardian pick up the student? *
If yes, please list:
Lunch will be provided. Please check one.
List any medical issues/concerns for student:
Transportation: Please check one:
T-Shirt Size (Adult):
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