Summer Camp Enrollment Form

Summer STEAM Camp Registration $150 a week. Includes breakfast, lunch, and 2 field trips a week!! 9-5pm Mon -Fri
CHILD INFORMATION:
Child Name *

First Name Last Name
Birth Date *

Month Day Year
Grade *
Name of School *
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
MEDICAL INFORMATION
Physician Name

First Name Last Name
Phone Number

Area Code Phone Number
Medical Concerns
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1 week camp payment $ 150.00
STEAM SUMMER CAMP 1 week

Total $ 0.00

Payment Methods

Debit or Credit Card

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

Summer STEAM Camp Registration $150 a week. Includes breakfast, lunch, and 2 field trips a week!! 9-5pm Mon -Fri