Young Dragons Summer Enrollment Form 2019
Young Dragons is a 6-week summer camp offered at no cost for middle school students in the West Philadelphia Promise Zone. This program is a partnership between The Malcolm Jenkins Foundation and Drexel University, providing innovative STEAM (Science, Technology, Engineering, Arts/Athletics, and Mathematics) developed specifically for 10-14 year-old learners. The program runs Mondays-Thursdays from June 17th through July 25th, 9:00 AM to 1:00 PM.

Participants should be rising 5th-8th graders residing in the West Philadelphia Promise Zone, an area served by the following middle schools: Alain Locke Elementary, Morton McMichael School, Martha Washington Elementary, Science Leadership Academy Middle School, and Belmont Charter School. For reference, the Promise Zone is indicated on this map;
bit.ly/WPPromiseZone

The deadline for application materials is Friday, May 31st, 2019.

Contact Zoe Jamison (zoe.v.jamison@drexel.edu) with any questions.

Young Dragons 2019 Application
Scholar Information (We call the students scholars!)
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
Your answer
Gender Identification *
T-shirt Size *
All sizes are adult unisex.
Do you have allergies, dietary restrictions, health problems, or medications that we should know about? If so, please describe below: *
Your answer
School Information
School Name *
Required
Grade (In Fall 2019) *
Communication Information
Scholar Email Address *
Your answer
Scholar Cell Phone Number (Optional)
Your answer
Scholar Home Mailing Address *
Your answer
Does your scholar have any brothers or sisters who are in or are graduates of the Lindy Scholars Program? If yes, who? *
Your answer
Name of Parent or Guardian *
Your answer
Email of Parent or Guardian *
Your answer
Cell Phone Number of Parent or Guardian *
Your answer
Home Phone Number of Parent or Guardian
Your answer
Relationship of Parent or Guardian to Scholar *
Your answer
Does parent/guardian live with student? *
If not, please provide the parent/guardian mailing address *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Cell Phone Number *
Your answer
Emergency Contact Home Phone Number
Your answer
Emergency Contact Relationship to Scholar *
Your answer
How did you hear about this program? *
Your answer
What website referred you to this application? *
I understand that I must also submit program permission forms and the informed consent, assumption of risk and release of liability form in order to participate in the program *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of ExCITe Center of Drexel University. Report Abuse - Terms of Service