Participant Registration Form

Participant Registration Form

Please fill the form below keenly and let us know if you give go ahead for this participation
- Student Name*
  
  First NameLast Name
- Gender*
- Age*
- Date of Birth*
  
  MonthDayYear
- Grade*
- Medical & Health Information
- Does the student have any allergies?
- If yes, please list: Enter NONE if no Allergies*
- Does the student have any medical conditions or require special accommodations?
- If yes, please describe: Enter NONE if no conditions or accommodation needed*
- Is the student currently taking any medication? We are not able to provide medication distribution.
- If yes, please list medications (include dosage if applicable): Enter NONE if no Mediations*
- Full Name
  
  First NameLast Name
- Relationship to Student:
- Primary Phone
- E-mail
  example@example.com
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- E-mail
  example@example.com
- Camp Registration Selection
- Camp Registration Selection For Ages 7 – 9:
  Please select the appropriate session based on your student’s age group.
- Camp Registration Selection For Ages 10 – 12:
  Please select the appropriate session based on your student’s age group.
- Camp Session Selection
- Camp Session Selection For Ages 7 – 9:
  Please select the appropriate session based on your student’s age group.
- Camp Session Selection For Ages 10 – 12:
  Please select the appropriate session based on your student’s age group.
- Additional Information
  Special Interests/Experience in S.T.E.A.M. (if any):
- Additional Comments or Special Requests:
- Consent and Acknowledgment | I hereby give permission for my child to participate in the 2025 North Florida Learning
  Center Summer S.T.E.A.M. Camp. I confirm that the information provided above is accurate to the best of my knowledge and agree to the camp’s policies and procedures.
- CONSENT FOR MEDICAL TREATMENT | As the parent or legal guardian of the above-named participant, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.
- By signing and submitting this registraiton form, you understand and agree to all policies.
  
  Once you click "Register" you will be redirected to pay the registration fee. You may use your credit/debit card or PayPal account to pay the fee.
- Parent/Guardian Signature*
  
  First NameLast Name
- Today's Date*
  
  MonthDayYear
  Date
- Should be Empty:

Participant Registration Form

Medical & Health Information

Camp Registration Selection

Camp Session Selection