SRU STEM Club Registration Form

STEM Club Registration

2025 - 2026 School Year
Student Information
Participant's Name*

First NameLast Name
STEM Club*
Birth Date*

MonthDayYear
Grade
Parent/Guardian Information
Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Does the participant have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Should be Empty:

STEM Club Registration