TRSA Summer Academy Wait List Application
We have already filled the spots for the 2018 Summer Academy, but please fill out this form to be placed on a waiting list in the event of cancellations.

Questions? Contact Jaime Christensen at jaime.christensen@tulsastem.org.

Email address *
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Mailing Address (for permission forms if e-mail is not applicable. )
Your answer
Student Name *
Your answer
Student Email Address *
Your answer
Student Phone Number *
Your answer
Best way to contact the student *
Student's School *
Your answer
School Address *
Your answer
Student's School District *
Your answer
Student Grade in Fall of 2018 *
Your answer
Student Age *
Your answer
Student Gender *
Student's T-shirt Size *
Which of the follow best represents the student's racial or ethnic heritage?
Medical Restrictions
Your answer
Current Medications
Your answer
Dietary Restrictions
Your answer
Student's Physician's Name
Your answer
Student's Physician's Number
Your answer
If unable to reach Parent/Guardian, please contact: *
Your answer
Relationship to emergency contact: *
Your answer
Contact Phone *
Your answer
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