Young STEM Professionals Summer Camp Enrollment Form

Summer Camp Registration

An email will be sent with On-Demand Virtual instructions after your registration has been received.
Registration Information
How did you find out about this Virtual Summer Camp?*

Big ThoughtCHATCedar Hill LibraryDallas City of LearningEngineering For Kids Dallas SWYoung STEM ProfessionalsYMCA of Metropolitan DallasSHE-EOOther
For which STEM Project are you registering (You may select more than one...Select all that apply)?*

Build a Sweet SkyscraperGerm ExperimentRubber Egg Mini-Experiment
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
School District
Name of School*
Student ID #*
or Lunch ID #
Student Email Address (if 13 years or older)
Example@example.com
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
MEDICAL INFORMATION
Physician Name

First NameLast Name
Phone Number

Area CodePhone Number
Medical Concerns
Hold Harmless Agreement
- I AGREE THAT I AM 18 YEARS OR OLDER, A PARENT OR GUARDIAN OF THE REGISTERED PARTICIPANT.
- I AGREE THAT I CAN LEGALLY ENTER INTO THIS AGREEMENT FOR THE REGISTERED PARTICIPANT.
- I AGREE BY REGISTERING MY CHILD INTO THE YOUNG STEM PROFESSIONALS VIRTUAL PROGRAMS OR VIRTUAL CLASSES, I RELEASE AND HOLD HARMLESS THE YOUNG STEM PROFESSIONALS, DALLAS CITY OF LEARNING, BIG THOUGHT, ENGINEERING FOR KIDS, LEADERSHIP DIAGNOSTICS LLC, ALL CONTENT PROVIDERS, MANAGEMENT, AND BOARD OF DIRECTORS FROM ANY AND ALL LIABILITY THAT MAY RESULT FROM THE REGISTERED CHILD PARTICIPANTING IN THE YOUNG STEM PROFESSIONALS VIRTUAL PROGRAM AND/OR CLASS .
Select*

I AGREE
Signature of Participant's Parent or Guardian*

Clear
Should be Empty:

Summer Camp Registration

Registration Information

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

MEDICAL INFORMATION

Hold Harmless Agreement