Summer 2020- Registration Form for VIRTUAL Summer Science Club
Summer Science Club 2020 Details:
Email Ms. Steph,
, with questions.
Who: Rising 1st through 7th Graders and Youth Interns
What: Summer Time STE(A)M Enrichment Club
When: July 6, 2020 - Aug 14, 2020
Where: Google Classroom- Virtual Camp (NO IN-PERSON CLASSES!)
Registration Fee: $1000 per Child- Scholarships Available
*Including mandatory $100 supply deposit
**Students outside of NYC: 25% distance discount
MANDATORY Parent Meeting: Monday, June 29, 2020, at 6 PM - via ZOOM
6th Annual Science Fair & Culmination Celebration: Friday, Aug 14th at 5 PM
Note: There are multiple sections of the form, please complete ALL sections.
Full Name of YOUTH PARTICIPANT
Current Age of Youth Participant as of July 6th, 2020
Date of Birth of Youth Participant
Grade child will enter in September 2020
I am registering the youth participant for:
daily camp attendance.
camp attendance once a week.
camp attendance twice a week.
Camp kit only: Science Gear and Art Supplies
Camp kit only: Science Gear, Art and Science Supplies
The youth participant is biologically
Full Name of ADULT COMPLETING THE FORM
Cell phone number of ADULT COMPLETING THE FORM
Relationship to Child
Aunt or Uncle
YOUTH PARTICIPANT'S Summer Address
HOME Address of ADULT COMPLETING the form
YOUTH PARTICIPANT'S T-shirt Size
Emergency Contact Information- List the names and contact phone numbers of three people OTHER than yourself who are authorized to pick-up the youth participant or who can be contacted in the case of an emergency.
How were you referred to Ms. Steph's Science Club?
What are your child's interests?
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