Building STEAAM Summer Camp June 5th - June 28th 2017

Application Information for Building STEAAM Summer Camp

* 1. Camper Last Name

* 2. Camper First Name

* 3. Camper Address

* 4. City, State and Zipcode

* 5. Camper birthdate

* 6. Camper current grade

* 7. Camper current school

* 8. Parent/Guardian name

* 9. Parent/Guardian phone

* 10. Parent/Guardian Email address

* 12. Does your camper have any medical conditions, allergies or special needs camp staff need to know about?

* 13. Does your camper have any behavior or emotional issues the staff should know about?

* 14. Is your camper taking any medications to treat these conditions?

* 15. Is there any other information about your camper that would be helpful to camp staff?

* 16. Emergency Contact Name

* 17. Which week(s) are you interested in? Check all that apply.

* 18. Emergency Contact Relationship

* 19. Emergency Contact phone

* 21. We will need before care beginning at

* 22. We will need after care until

* 23. There are no scholarships remaining.  All payments for each week are due by that Sunday at 11:59 pm.  Please list your intended payment plan.  A brief parent orientation is required prior to beginning camp. Please contact Simone Bess to set up an orientation.  513.720.2323

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