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 Grade Level (upcoming school year) Age 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 12-16) 9 am - 5pm at ROCK Community Center Yes No Week 1 (June 12-16) 9 am - 5pm at ROCK Community Center Availability menu Week 2 (June 19-23) 9 am - 5pm at ROCK Community Center Yes No Week 2 (June 19-23) 9 am - 5pm at ROCK Community Center Availability menu Week 3 (June 26-30) 9 am - 5pm at ROCK Community Center Yes No Week 3 (June 26-30) 9 am - 5pm at ROCK Community Center Availability menu Week 4 (July 3-7) 9 am - 5pm at ROCK Community Center Yes No Week 4 (July 3-7) 9 am - 5pm at ROCK Community Center Availability menu Week 5 (July 10-14) 9 am - 5pm at ROCK Community Center Yes No Week 5 (July 10-14) 9 am - 5pm at ROCK Community Center Availability menu Week 6 (17-21) 9 am - 5pm at Martin University Yes No Week 6 (17-21) 9 am - 5pm at Martin University Availability menu Week 7 (24-28) 9 am - 5pm at Martin University Yes No Week 7 (24-28) 9 am - 5pm at Martin University Availability menu Question Title * 4. Check all of the dates your child(ren) can attend STEM@the ROCK for the week of June 12. June 12 June 13 June 14 June 15 June 16 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 19. June 20 June 21 June 22 June 23 Not available this week. Question Title * 6. Check all of the dates your child(ren) can attend STEM@the ROCK for the week of June 26. June 26 June 27 June 28 June 29 June 30 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 3. July 3 July 5 July 6 July 7 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 10. July 10 July 11 July 12 July 13 July 14 Not available this week. Question Title * 9. Check all of the dates your child(ren) can attend STEM@the ROCK for the week of July 17 July 17 July 18 July 19 July 20 July 21 Not available this week. Question Title * 10. Check all of the dates your child(ren) can attend STEM@the ROCK for the week of July 24. July 24 July 25 July 26 July 27 July 28 Not available this week. Next