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): *
Required
Student's Current School (2018-2019): *
Your answer
Choose the Session (PM ONLY): *
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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