Camp Enrollment

Camp Enrollment

2026
E-mail:*
Registration fee (not a deposit-non refundable): $207.91

Includes:
- Branded Bag
- Branded Water Bottle
- Branded Lab Coat
- Branded T-shirt (worn on field trip days)
- Stethoscope
How did you hear about us?
Please select one:*

Private PaySubsidy
Please select one:*

Discounted Enrollment ($100.00 off per week for 8 week camp enrollment- excludes before/after care)
Child's Full Name:*

PrefixFirst NameLast Name
Child's Nick Name:
Child's Date of Birth:*
MM/DD/YYYY
For reporting purposes, please indicate your child's ethnicity (optional):

African AmericanLatino/HispanicCaucasianNative AmericanAsian AmericanOther
Enrollment Options ($2,940.00 for 8 week camp, or $472.50 weekly- minimum 2 weeks required):*

Early Care 7:30-8:30 am (billed once camp begins)Mon-Fri 8:30 am-2:30 pmAfter care 2:30-5:30 pm (billed once camp begins)
Early Care Options ($15.75/day):

MondayTuesdayWednesdayThursdayFriday
Aftercare Options ($19.43/day):

MondayTuesdayWednesdayThursdayFriday
Camp Weeks (select 2 or more):*

Week 1: Becoming a Doctor (6/22-26)Week 2: Inside the Human Body (7/6-10)Week 3: How the Body Works (7/13-17)Week 4: First Aid & Emergency Care (7/20-24)Week 5: Medical Specialty Rotations (7/27-31)Week 6: Patient Care & Healing (8/3-7)Week 7: Surgery & Dissections (8/10-14)Week 8: Match Week & Mini Med Camp Family Celebration (8/17-21)
Summer*

2026
All known food and/or drug allergies:*
Any medical conditions or learning or physical disabilities of which we should be aware of:*
Child's T-shirt Size (Youth):*

3T4T5T6TOther
How does your child feel about camp and being left by their parents?*
Are there any recent traumatic situations your child has been exposed to such as a death in the family, divorce, new sibling, etc.?*
What is your child's temperament? Are they easy going, quiet, hard to please, demanding, aggressive, etc.?*
What is your child's favorite food?*
What is your child's least favorite food?*
Child's Health Records (a copy of your students immunizations and current health report are required-attached). You may upload now or bring in on their first day of attendance:

Browse Files

Cancelof
Browse Files

Cancelof
Download & Print Child Health Report.
Are there any medications your child will be taking while at camp? *
Please include any medical papers necessary in case of an emergency. Non-prescription medication and prescription must be signed in during attendance.
Does your child verbalize when they have to use the bathroom?*
Do they use special words when they have to use the bathroom?*
Does your child have any security objects such as a blanket, toy, etc.? *
Are there any other comments or information you would like us to know?
Physicians Name:*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Insurance Name:*
ID:*
Group:
Parents Full Name*

First NameLast Name
Annual Household Income (optional):

0-$19,999$20-39,999$40-49,999$50-59,999$60-89,999$90-119,999$120+
Highest Level of Education (optional):

Up to 8th gradeSome High SchoolHigh School GraduateSome CollegeCollege GraduateMastersPhD/MD/JD
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:*

Area CodePhone Number
Parents Full Name

First NameLast Name
Email
example@example.com
Annual Household Income (optional):

0-$19,999$20-39,999$40-49,999$50-59,999$60-89,999$90-119,999$120+
Highest Level of Education (optional):

Up to 8th gradeSome High SchoolHigh School GraduateSome CollegeCollege GraduateMastersPhD/MD/JD
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:

Area CodePhone Number
Emergency Contact Name:*
Emergency Contact Number:*
Emergency Contact Name:
Emergency Contact Number:
Authorized to Pick up/Drop off
Name:*
Relationship to Student:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone: *
Name:*
Relationship to Student:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone:*
I understand that as a part of Stem Prep Academy, my child may be videotaped, audiotaped, interviewed, and/or photographed and agree to allow Stem Prep Academy to keep, as Stem Prep Academy property, the products of such videotaping, audiotaping, interviewing, and/or photographing. I agree that such material, along with my child’s name, may be used, and posted on the Stem Prep Academy's website, Instagram, and Facebook, for promoting and in any publicity generated by Stem Prep Academy. I also understand that my child may be asked to do or participate in projects that may also be used by Stem Prep Academy for publication in a variety of forums newsletters, websites, and other publications, and that no compensation will be paid for such use.

I understand that participating in Stem Prep Academy allows my child no special rights or expectations regarding Stem Prep Academy, including the right to sue any party involved in the implementation and execution of the Stem Prep Academy's programs. I agree to hold harmless Stem Prep Academy, its agents, and employees from all claims, damages, losses, injuries, and expenses arising out of or resulting from participation in these activities. I further agree not to sue Stem Prep Academy, their agents, and employees for any actions or causes of action, including the negligence of Stem Prep Academy arising out of participation in this program.
I agree
I disagree
Tuition: Summer camp tuition is due at the time of registration if selecting 2 weeks. If registering for 3 or more weeks, flexible payment plans are available.

Enrollment: $207.91 Registration fee is due when submitting this form.

Refund: Tuition, registration, and all fees are non-refundable. Days missed can not be credited.

Partial refunds will not be made if days are missed, or your child is unable to attend. Stem Prep Academy will apply a $50.00 reversal fee for payments that are returned. A late $5 fee per minute will be administered if your child is not picked up within 5 minutes of their scheduled time. This must be paid before your child returns. Tuition is not prorated, families pay for slots in which tuition is a set amount monthly (school year) or weekly (summer).

OBTAINING EMERGENCY MEDICAL CARE AND ADMIN. OF MINOR FIRST AID PROCEDURES: THE PARENT'S SIGNATURE IS REQUIRED FOR EACH ITEM BELOW TO INDICATE PARENTAL CONSENT!

1. WALKS AND TRIPS

2. TRANSPORTATION BY THE FACILITY

3. WADING
Tuition (for administrative use only)
Signature*

Clear
Name*

First NameLast Name
Date*
Please Sign:*

Clear
Directors Signature:

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My Products

Registration Fee$207.91

not a deposit (non-refundable)

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Total $0.00

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Camp Enrollment

Authorized to Pick up/Drop off

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