Camp Registration &#8211; Pink S.T.E.M. for Girls

STEMulate Your Mind Registration Classes and Camps

Name of Student

DOB

Date

Grade Level

Gender

Military Dependent?

GA Caps Prgram Number

Name of Parent/ Legal Guardian

Phone(c)

Format: (000) 000-0000.

Phone(w)

Format: (000) 000-0000.

Email

example@example.com

Notification person 1

thead@pinksteminc.com

Notification person 2

Notification person 3

pinksteminterns@pinksteminc.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry of Residence

Emergency Contact List(other than parents)/Authorized Pickup List

I give permission for my child to be photographed. I understand the photographs are the property of PinkSTEM and may be used in any manner including but not limited to promotional (media,flyers,banners,etc.) related material to PinkSTEM.

Signature

MEDICAL INFORMATION

Please state any health information or allergies we may need to know. If your child has special needs, please let us know. We want to help our staff be prepared for the needs of your child. Food items are sometimes used during our programs. Please use additional paper if needed. (Mandatory medications be left at the front desk prior to drop off with instructions prior to each session)

List below, are there any present medications?

Should your child be restricted from any activity?

If yes so, please explain any restrictions and list all medications:

Release and Waiver of Liability (Initial when attached form is completed)

https://form.jotform.com/250444878160460

In the event my child suffers an illness or accident requiring medical treatment while involved in PinkSTEM and/or Pink STEM Foundation activeities referred to collectively as (Pink STEM), I hereby give permission for any necessary hospitalization, medication, or surgery on recommendation of medical personnel, in which case all such expenses shall be paid by me. In the event of sickness or accident, I waive all claims against PinkSTEM, PinkSTEM Partners, its members, officers, agents, employees, and volunteers that may arise from participants in the activities of PinkSTEM. The undersigned hereby acknowledges that they have read, understand, and agree to all documents related to PinkSTEM programs, including the Handbook/Guidelines and Discipline policy. The undersigned hereby waives all claims against PinkSTEM and its employees or volunteer workers for injury,accident or illness by reason of participation in the PinkSTEM program.

Signature

Date

Total

Scholarship Recipient

Pink S.T.E.M. T-Shirt Size

Add Discount Code Here

CANCELLATION POLICY

All sales are final. No refunds, cancellations must be received with a 30 day written notice and reasonable verification given to Pink S.T.E.M.Inc via email thead@pinksteminc.com. A 25% cancellation fee will be deducted before a 30-day Cancellation, a 50% cancellation fee will be deducted within 30 days. Camp Directors have the right to deny all refunds within the 30 day window. Your tuition may be transferred to a future class that occurs prior to December 2027, but only immediately upon your cancellation. No refund or transfer requests will be accepted within five (5) business days of the start of a class or if you do not attend.
*A 10% administrative fee is retained for cancellations not initiated by Pink S.T. E.M. Inc.
Payment is required by noon on Thursday before the first class in order to reserve your spot in the class.

Camp Fees- All Fees are nonrefundable- see policy above!

$250 Camp Fee

$250.00 Quantity

$125 Camp Fee

$125.00 Quantity

$100 Camp Fee

$100.00 Quantity

$300 Camp Fee

$300.00 Quantity

$50 Afterschool Fee

$50.00 Quantity

$65 Afterschool Fee

$65.00 Quantity

$75 Camp Fee

$75.00 Quantity

$150 Camp Fee

$150.00 Quantity

Max Touch Scholar

Congratulations of being a Max Touch Cares Scholar! Your Fee is Waived for Camp.

Free

Girls Dig Deep Scholar

Congratulations on Being a Member of Girls Dig Deep. Your sposorship was paid by Robins AFB through the Air & Space STEM, which is DOD Funding. We are excited to have you on Board.

Free

Bibb County GEAR Up Scholar

Congratulations of being a GEAR Up Bibb County Students, your fee is free.

Free Quantity

Sacred Heart Lego Camp Fee

$40.00 Quantity

Sacred Heart Lego Camp Fee

$75.00 Quantity

Enter coupon

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

REGISTRATION

Camp Fees- All Fees are nonrefundable- see policy above!