Clarkston Community Center STEAM-Plus 2021 Summer Camp Registration Form
First week of camp is free. Starting June 15th, we will start accepting weekly payments of $35. Campers will be separated into groups based on grade level and will be socially distanced.
Child's Information
Parent(s)/Guardian(s) Information
Please list in order of whom to contact first
*
Demographic Information
American Indian/Alaskan Native
Asian Indian
Black/African American
Chinese
Filipino
Guamanian or Chamarro
Japanese
Korean
Native Hawaiian
Somaon
Vietnamese
Caucasian
Other
If other please type in your demographic information:
Parent's Highest Level of Education (please select one):
Did not complete High School
High School Diploma/GED
Technical/Vocational School
Some College
Associates Degree
Bachelor's Degree
Advanced Degree
Country of Origin
Primary Language
English Speaking Level (Select One):
Fluent
Intermediate
Beginner
None
English Reading Level (Select One):
Fluent
Intermediate
Beginner
None
English Writing Level (Select One):
Fluent
Intermediate
Beginner
None
What is your child's gmail account? (You & your child will receive important updates)
Would you like to participate in our Youth Decoded Course? (Youth Decoded is an in-depth coding program provided by the DeKalb County Offices of Youth Services)
Yes
No
Do you have access to a home desktop or laptop?
Yes
No
Does your child(ren) receive free or reduced lunch?
Yes
No
Annual Income
$0
$1-$14,999
$15-29,999
$30,000-$44,999
$45,000+
If you are eligible, are you interested in receiving a DeKalb County summer camp voucher (must be a resident in DeKalb County)?
Yes
No
Date of Registration
-
Month
-
Day
Year
Date
Submit
Questions? Please contact Eric Williams at 404-508-1050 or email at youth@clarkstoncommunitycenter.org.
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