Register

Child Name

First and Last NameD.O.B.

Child Name

First and Last NameD.O.B.

Child Name

First and Last NameD.O.B.

Child Name

First and Last NameD.O.B.

Parent/Guardian Information

Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState

Zip Code

Email

example@example.com

Emergency Information

Emergency Contact 1

First NameLast Name

Phone Number

Format: (000) 000-0000.

Emergency Contact 2

First NameLast Name

Phone Number

Format: (000) 000-0000.

Relationship Emergency Contact 1

I give permission for the person listed below to sign my child out of the program in case of medical or other emergency, If I am not to arrive on time, or able to be contacted.. If I select a different person, I will sent a note by text to 404.725.0873, or an email to programs@leanintostem.org. A Government issue is required for identification.

First NameLast Name

Phone Number of above person

Format: (000) 000-0000.

Do any of the children listed above have known allergies, chronic illness, or medical conditions, or special needs? Also note below if your child has behavioral challenge, or social challenges that we need to be aware of . If yes, please list the name of the child and describe the condition, and or any other special needs. Please provide on 1st day of arrival any medication your child is taken, Dr. Information and instructions. Information provided is confidential.

How did you hear about our STEM Programs?

Signature

Authorization to attend camp/event

I have enrolled my child or children in the LEAN into STEM Camp and or STEM events hosted by Diaspora Global Foundation. I give authorization for my child or children to participate in all activities during event hours. It is also my responsibilty to contact the phone number noted on this websiteto notify the event staff of any late pickup, emergency situtation or special pickup insructions.

Note Some events require the parent attendance on site through out the event. Please note that in the event description and plan accordingly.

I understand that that some STEM activities may require the child to stand, sit, kneel, jump, bend over or other physical activites to participate. It is the parent/guardian responsibility to make sure that the child or children is properly dressed, fed, hydrated, and that hygiene and clothes is clean daily. Inapproprate clothing will not be accepted. The parent will be notified to bring a change of clothing to the camp.

Cancellation and refund (see changes below)

Once paid, STEM event fees are not refundable except in the case of a medical emergency or if a child is dismissed due to behavior issues. which concerns either the child, children, or the parent(s). In the event of such emergency fees paid will be refunded based on a prorated rate of the number of days that the child or children attended. A 15% administrative fee will also apply to the cancellation. The said emergency notification must be accompanied by a note from the hospital, or attending medical staff. Our dismissal of a student refund will also be given as noted above

Meals

Meals are not included, unless stated. Please provide lunch. Sugar drinks, juices, sugar snacks, etc should not be included in the child's lunch, unless it is necessary medically.

Note - Peanut meals and or peanut snacks of any kind is not permitted. Please do not put these items in your child's clothing, lunch or carry bags.

Permission to use the main contact number above to send text or messages regarding specific camp communications, newsletters, or upcoming events. Select and sign below.

Signature

Permission for the children or child images to be taken during STEM events sessions for the purposes of creating video of the experience, or for advertising our programs. on our website. Note, this permission is for all children or child listed above. Should you wish to not have a particular child photographed, please note that in the comment section.