Language
English (US)
2023 SUMMER CAMP REGISTRATION
July 17-21 | 8:30AM-12:30PM
Student's Name (Each student will need a separate registration)
*
First Name
Last Name
Student's gender
*
Male
Female
Other
Student's Age
*
Ethnicity
*
African American
Hispanic
Asian
Caucasian
Other
Grade as of 2022-2023 academic school year?
*
K-2
3-5
Current School District
*
Parent email
*
Parent cell phone number
*
Please enter a valid phone number.
Parent Highest Degree of Education
*
No degree
High School Diploma or GED
Some College
Associates
Bachelor's Degree
Master's Degree
Doctorate or higher
Parent/Household Annual Income *(Private for grant info only will not be shared)
*
$0-$24,999
$25,000-$49,999
$50,000-$99,999
$100,000-$149,999
$150,000+
Emergency Contact Name
*
First Name
Last Name
Relationship
Please Select
Mother
Father
Grandparent
Aunt
Uncle
Sibling
Babysitter/Nanny
Other
Does the student have any special needs, allergies, chronic illness, or medical conditions? If yes, please describe.
*
Sloan STEM + Arts staff or volunteers can not administer medications during the camp.
Have the student taken the COVID 19 vaccination?
*
Yes
No
I don't wish to answer
PAYMENT
*
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SINGLE STUDENT REGISTRATION
WEEK ENROLLMENT OF SUMMER CAMP
$
200.00
SPONSORSHIP
SPONSOR A CHILD OR SEVERAL
$
200.00
# of Kids
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Item subtotal:
$
0.00
DONATION
SPONSORSHIP
$
1,000.00
CAMP
EQUIPMENT
MAJOR
TITLE SPONOSR
Item subtotal:
$
0.00
DONATION 2
SPONSORSHIP
$
1,000.00
CAMP
EQUIPMENT
MAJOR
TITLE SPONOSR
Item subtotal:
$
0.00
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