STEAM Summer 2021 Registration Form

STEAM Summer 2021 Registration Form

Thanks for your registering in Olive Children | Berkeley Academy STEAM Summer 2021. The camp dates are from June 14 to August 20, bi-week sessions. The camper incoming grade level are from G1 - G2. Please fill out the field as it indicated.

Please select session(s) your child would like to attend.

	6/14 - 6/25	6/28 - 7/9	7/12 - 7/23	7/26 - 8/6	8/9 - 8/20
Please Select

Do your child need extended care? *
Student General Information
Campus you would like to attend *
Mission: 43531 Mission Blvd; SJ: 34700 Fremont Blvd
Please select your child's grade level? *
Student Full Name *

First Name Last Name
Birth Date

Month Day Year
Gender *
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parents General Information
Mother Full Name *

First Name Last Name
Mother Email Address *

Confirmation Email example@example.com
Mother Phone Number *

Area Code Phone Number
Father Full Name *

First Name Last Name
Father Email Address *

Confirmation Email example@example.com
Father Phone Number *

Area Code Phone Number
STEAM Summer 2021 registration *
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Registration Fee It is not refundable.
$ 100.00

Total

$ 0.00
Should be Empty:

Student General Information