STEAM SUMMER CAMP
Which Session would you like? Morning or Afternoon?
9:00 - 12:00
1:00 - 4:00
Child's First Name
Child's Last Name
Birth Month
Birth Date
Birth Year
Age as of June 20, 2026
Medical Condition that could affect the care of child?
Yes
No
If yes, please list:
Medications that child is taking:
Allergies:
Mother’s Name
Mother's Phone Number
Format: (000) 000-0000.
Father’s Name
Father's Phone Number
Format: (000) 000-0000.
Emergency Contact:
Relationship to child
Phone number
Format: (000) 000-0000.
Is there anything else you would like me to know about your child
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