STEM Camp Registration Form
Email address *
Student Name *
Your answer
Student Age *
Your answer
Student Gender *
Student T-Shirt Size
Parent/Guardian Name *
Your answer
Parent/Guardian T-Shirt Size
Address *
Your answer
Mobile Phone Number *
Your answer
Work Phone Number *
Your answer
Any medical conditions we should be aware of? *
Please list medication conditions if any.
Your answer
We provide a small snacks each day. Does your student have any food allergies or dietary restrictions? *
Please list food allergies or dietary restrictions? if any.
Your answer
In case of an emergency, every effort will be made to contact the parent/guardian of the student. If the parent/guardian is unreachable we will contact the below listed person ( s ). Please provide name and phone number.
Your answer
How did you find out about us? *
Your answer
I agree to pay the camp registration fee of $250 per student. One form per student. Please make Payment below. *
Terms and Conditions
I understand that my student will be participating in hand - on activities on and off the water as well as indoors and outdoors. I understand that e very precaution will be taken to ensure the safety of my student while participating in these activities . In consideration of the risk of injury while participating in the STEM Kids Summer Camp, I hereby knowingly and voluntarily enter into this waiver and release of liability and forever discharge camp staff, and associated individuals and/or entities of any claim of liability in regards to personal injury that my student may suffer as a direct result of participating in the Camp.
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This form was created inside of WJM4 Group of Companies.