Tutor Doctor Summer STEM Camp Registration
Email address *
Please select which Summer STEM Camp you would like to register for: * *
First Name of Camper *
Your answer
Last Name of Camper *
Your answer
Age of Camper *
Your answer
Grade of Camper *
Guardian / Parent's Name *
Your answer
Guardian / Parent's Phone Number *
Your answer
Emergency Contact *
Your answer
Emergency Contact Phone # *
Your answer
Family Doctor Name *
Your answer
Family Doctor Phone # *
Your answer
Are there any medical conditions we need to know about? *
Your answer
Is there any medication the camper will have with them?
Your answer
Waiver of Liability
I permit my child to attend the Tutor Doctor STEM Summer Camp. I, the undersigned, provide permission for my child to participate in the full range of program/camp activities, unless I notify you otherwise in writing. I authorize the Camp Director, or their designates, in the event of accident or illness affecting my child, to approve all procedures and related expenses, including admission to hospital, surgery, anesthesia, injections, or any other necessary treatment therein, as deemed essential for the care and well-being of my child. Such action is to be taken only when immediate contact with the undersigned, or the emergency contact person, cannot be made. I agree that, having taken such precautions as in your discretion are deemed advisable, Tutor Doctor STEM Summer Camp shall not be held responsible for any accident or sickness affecting my child, or for any loss or damage to his/her personal property. I understand that, should my child, in the judgment of the Camp Director, become a hazard to him/herself or to others at the camp, he or she may be sent home from the camp without refund. To the best of my knowledge, my child is in good health. I agree to inform Tutor Doctor STEM Summer Camp of any infectious diseases, which my child may have been exposed to during the three weeks prior to arriving at the program/camp.
Guardian/Parent Name *
Your answer
I Grant Permission *
A copy of your responses will be emailed to the address you provided.
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