Elementary STEM Day: Fri, June 21, 2019

Provided by Shorecrest High School Technology Student Association (TSA)

Please fill out one application per student.

NOTE: AM is full! There is still room in PM.

Email address *

Student's First Name: *

Your answer

Student's Last Name:

Your answer

Age (grade currently completing): *

1st or 2nd grade

3rd or 4th grade

5th or 6th grade

Required

Student's Current School (2018-2019): *

Your answer

Choose the Session (PM ONLY): *

PM (1:00 - 4:00)

Friend Request - please list a friend your child would like to be grouped with.

Your answer

Contact Information

Please list two names and phone numbers of people who can be reached during the event.

Name: *

Your answer

Phone Number: *

Your answer

Name: *

Your answer

Phone Number: *

Your answer

List of names who can pick up the child (photo ID required). *

Your answer

Allergy / Medical / Additional Information:

Your answer

Family Physician's Name and Phone Number:

Your answer

Family Insurance Company and Policy Number:

Your answer

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