STEM@theROCK Student Sign Up Parent/Guardian and Student Sign Up Question Title * 1. Please provide the following information for the Parent/Guardian First Name Last Name Phone Number Home Address Zip Code Email Address Relationship to Student Question Title * 2. Please provide the following information for the Student First Name Last Name Age Home Address Grade Level (upcoming school year) What school did they attend this past school year? What school will they be attending for the upcoming school year? Any food allergies? If so, please list them. Any dietary preferences? (For example vegan -no dairy, no egg, vegetarian, gluten-free, etc.) Question Title * 3. Please select the dates that your child will be attending Availability Week 1 (June 17- 21) 1-6pm at ROCK Community Center Yes No Week 1 (June 17- 21) 1-6pm at ROCK Community Center Availability menu Week 2 (June 24-28) 1-6pm at ROCK Community Center Yes No Week 2 (June 24-28) 1-6pm at ROCK Community Center Availability menu Week 3 (July 1-5) 1-6pm at ROCK Community Center Yes No Week 3 (July 1-5) 1-6pm at ROCK Community Center Availability menu Week 4 (July 8-12) 1-6pm at ROCK Community Center Yes No Week 4 (July 8-12) 1-6pm at ROCK Community Center Availability menu Week 5 (July 15-19) 1-6pm at ROCK Community Center Yes No Week 5 (July 15-19) 1-6pm at ROCK Community Center Availability menu Question Title * 4. Check all of the dates your child(ren) can attend STEM@the ROCK for the week of June 17. June 17 June 18 June 20 June 21 Not available this week Question Title * 5. Check all of the dates your child(ren) can attend STEM@the ROCK for the week of June 24. June 24 June 25 June 26 June 27 June 28 Not available this week. Question Title * 6. Check all of the dates your child(ren) can attend STEM@the ROCK for the week of July 1 July 1 July 2 July 3 July 5 Not available this week. Question Title * 7. Check all of the dates your child(ren) can attend STEM@the ROCK for the week of July 8. July 8 July 9 July 10 July 1 July 12 Not available this week. Question Title * 8. Check all of the dates your child(ren) can attend STEM@the ROCK for the week of July 15. July 15 July 16 July 17 July 18 July 19 Not available this week. Next