STEAM Camp Enrollment Form

Spring Break STEAM Enrichment Registration

Please Note: Spring Break Camp will be held at Greater New Zion Hope Center located at 1005 NE 28th St., OKC, OK 73111. Camp Hours are 9:00am - 4:00pm with drop off beginning at 8:30am and pick up ending at 4:15pm. Before and aftercare are available for an additional fee. Breakfast, lunch, and a snack are provided. Students are encouraged to bring a reusable water bottle. *See terms and conditions for additional details.
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Child Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Child Name

First NameLast Name
Birth Date

MonthDayYear
Grade
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
Emergency Contact 1*
First and Last Name/ Relationship
Emergency Contact 1 Phone Number *
Emergency Contact 2
First and Last Name/ Relationship
Emergency Contact 2 Phone Number
Physician Name

First NameLast Name
Phone Number

Area CodePhone Number
Medical Concerns*
Please include any allergies. Type N/A for no allergies.
Do you need Before/After Camp Care?

Yes, I need before care (7:00am-8:30am) and after care (4:15pm-5:30pm) for $5/day.No, my camper will attend camp from 9:00am-4:00pm (Drop off beings at 8:30am; Pick up ends at 4:15pm)

My Products

SPRING BREAK STEAM CAMP March 13th-17th$85.00

Field Trip Day included! Students will enjoy 5 days of STEAM (Science, Technology, Engineering, Art and Math) activities. Activities will include science projects, spring inspired art, engineering challenges, culinary arts, and a field trip to the Oklahoma City Museum of Art!

Quantity

School Break Day Drop In - Sold Out$20.00

Day options are available for students to come in and enjoy a fun filled day of STEAM activities while school is out! Please note: March 17th is a field trip day and Day Drop In is unavailable.

Select Day	Quantity
Monday, March 13th
Tuesday, March 14th
Wednesday, March 15th
Thursday, March 16th

Enter coupon

Total $0.00

For questions or assistance email info@pteinc.org or call (405) 254-8848.

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

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Spring Break STEAM Enrichment Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

MEDICAL INFORMATION