Fall Mini Camp 2019
The Fall STEM mini-camp will be on Monday, November 11th, 2019. Please complete the following application and Health History form.
Email address *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Gender *
Child's Date of Birth *
Your answer
Select your child's CURRENT grade *
What school does your child attend? *
Required
Primary Parent First Name (owner of email address listed above) *
Your answer
Primary Parent Last Name *
Your answer
Street Address *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Secondary Emergency Contact Name *
Your answer
Secondary Emergency Phone Number *
Your answer
Select a lunch option. *
Has your Science Maniac participated in one these programs before? (Select all that apply) *
Required
How did you hear about SciTech? *
I affirm that the above information is accurate and was completed by the SciTech participant and parent(s) or guardian(s). We agree to participate in any indicated orientation prior to the beginning of SciTech and to be governed by SciTech's staff, rules, and regulations. By selecting the "YES" response you are authorizing the applicant to participate in the SciTech Program. You are also giving permission for the minor child to be photographed as well as participate in any field trips during all SciTech program.You are also agreeing to abide by the code of conduct set by SciTech. (See SciTech website for code of conduct). *
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