SUMMER CAMP 2019 REGISTRATION FORM
Please fill out this form once per season per child. This form is mandatory to complete your child's registration in camp.
CAMP LOCATION *
STUDENT NAME *
Your answer
PARENT EMAIL (s) *
Your answer
PARENT CONTACT NO.S
Your answer
HOME ADDRESS
Your answer
AGE GROUP *
STUDENT BIRTHDAY (MM/DD/YY) *
Your answer
RISING GRADE *
Your answer
SCHOOL ATTENDING *
Your answer
EMERGENCY CONTACT NAME/ NUMBER/ RELATIONSHIP *
Your answer
PERSON (s) AUTHORIZED TO PICK UP STUDENT *
Your answer
STUDENT T-SHIRT SIZE (Strem HQ will provide 1 tshirt with camp; additional t-shirts can be purchased) *
Specify desired Camp Week & Camp Name *
Your answer
How did you hear about us? *
Photo/ Video Release- " STREM HQ requests your permission to use the above mentioned student's image when he/she is participating in our activities. Images are used solely to support STREM HQ and our mission. Image use includes brochures, websites and other STREM HQ publications. If you wish your student is not photographed please email us with your child and camp name. Please note students might be photographed in groups and during camp / class activities. *
Attn: Master / Expert age groups - Some Engineering camps will require soldering and working with electronics and tools. By enrolling in such camps you give permission to your child to use such tools, devices. You agree that your child is fully capable of handling such tools and will follow instructions at all times. STREM HQ will not be held liable for any incidents at any time. *
Medical Info- Does your child have any special requirements/ allergies etc? (If yes, Please Specify- You will need to provide a doctors note & fill out a Medical form to administer any medications ) *
Your answer
Health Insurance Information (Please add name / contact / Group Number - All that applies) *
Your answer
Primary care physician *
Your answer
In case of severe emergencies/ severe allergic reactions we will call 911 . Parents assume all responsibility of cost of emergency care. *
I have read and understood and agree to the STREM HQ guidelines in the STREMHQ Parent Handbook. https://www.stremhq.com/faq *
I agree to Liability release and waiver of legal rights. https://www.stremhq.com/contractsandagreements *
I agree to the STREM HQ behavior contract. and agree that STREM HQ reserves the right to suspend the student if they do not follow rules and brings harm to person or property. I understand that no refunds will be provided if my child is suspended from the program. https://www.stremhq.com/contractsandagreements *
I have read and understand the STREM HQ refund policy as stated in parent handbook and FAQ. https://www.stremhq.com/faq *
I agree to the exemption. ( I understand that STREM HQ is not licensed by the state as a child care center. It is exempted because it is a Summer Camp Program.) *
Electronic Signature: By signing below I affirm that I have reviewed and agree to all agreements and waivers. *
Your answer
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