STEM Camp Student Interest Form/Formulario Para Estudiantes Interesados
LOTTERY ROUND 1 - Completed

LOTTERY ROUND 2 - Wait list OPEN
*Please complete this form to register your student for the North Atlanta Cluster Elementary Summer School STEM Camp lottery by April 19th.
*The lottery will consist of filling in gaps from the first round of lottery students and possibly creating additional classes based on response.
*Round 2 should occur around May 1st.

Home School/Colegio de Estudiante *
Student Last Name/Colegio de Estudiante *
Your answer
Student First Name/Apellido *
Your answer
Student ID *
Your answer
2019-2020 Grade Level/Curso *
Parent Name (Last, First)/Nombre de padre o madre (nombre, apellido) *
Your answer
Home Address/Dirección *
Your answer
Parent Email Address/Correo electrónico (de los padres) *
Your answer
Parent Phone Number/Correo electrónico (de los padres) *
Your answer
Name of Alternate Emergency Contact/Contacto de Emergencia Alternativo *
Your answer
Emergency Contact Relationship (Other parent, grandparent, etc..) *
Your answer
Emergency Contact Number/Contacto de Emergencia *
Your answer
Services your child currently receives? *
Required
Does your child have any dietary needs or allergies?
Your answer
Session(s) of Interest/Sesión de Interés *
Required
How will your child be getting to camp? *
How will your child be getting home from camp? *
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