Student Name *

Student grade next school year 2026-27 (rising 4th-7th graders are invited to STEM camp) *

#1 Parent/Guardian Name *

#1 Parent/Guardian contact phone number *

#1 Parent/Guardian email *

# 2 Parent/Guardian Name *

# 2 Parent/Guardian contact phone number *

#1 Emergency Contact name *

#1 Emergency Contact phone number *

Please list any health concerns or ALLERGIES for the student. *

Who is authorized to pick up the student from STEM camp? *

During school registration for the 2025-2026 school year you signed a permission form for field trips. Type YES if you approve of your child participating in a field trip during STEM camp. *

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