Camp Application
You will be notified of your child’s acceptance to the STEM Camp by e-mail or phone. The submission of this form implies I have read and understand the above application form and the Video Release form. I also certify that I am a legal guardian of the child listed in this application and I give approval for my child to attend the FPTC Summer STEM Camp.

DATE: MAY 30th- JUNE 2nd
8:00 a.m. - 2:30 p.m.
LUNCH and SNACKS will be provided.
Student Name: *
Your answer
Gender
Age
Your answer
School District 2016-17
(Washington, Holmes, Jackson, etc.)
Your answer
Parent/Guardian Name *
Your answer
*
Address
Your answer
Phone: *
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone Number *
Your answer
T-shirt Size *
Video Release *
For More Information or Questions please Call:
Kathy Nelson @ 638-1180 Ext. 372
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