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. An email will be send confirming enrollment and identifying an orientation.  At least two orientation options will be provided.  A final enrollment notice will be sent once orientation is complete and payments or payment arrangements have been made.  Please indicate your payment intentions or if scholarships or partial scholarships are requested.

* 19. Emergency Contact Relationship

* 20. Emergency Contact phone

* 22. We will need before care beginning at

* 23. We will need after care until

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