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  • PROGRAM ENROLLMENT FORM

  • SECTION I

  • APPLICANT INFORMATION

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  • APPLICANT ADDRESS

  • APPLICANT CONTACT INFORMATION

  • SECTION II

  • PARENT/GUARDIAN CONTACT INFORMATION 1 (REQUIRED FOR APPLICANTS UNDER 18)

  • PARENT/GUARDIAN CONTACT INFORMATION 2

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  • SECTION III

  • EMERGENCY CONTACT INFORMATION

  • SECTION IV

  • HEALTH INFORMATION

  • SECTION V

  • DISMISSAL INFORMATION

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  • PRIVACY NOTICE

  • STEM in the Rockaways is committed to protecting your personal information. All sensitive data will be kept confidential and used only for program purposes. For more information, please visit our Privacy Policy on our website.

  • MEDIA CONSENT AGREEMENT

  • By participating in programs and activities hosted by STEM in the Rockaways, you acknowledge and agree that photographs, videos, or audio recordings of participants may be taken during events or sessions. These media materials may be used by STEM in the Rockaways for promotional purposes, including but not limited to social media posts, emails, brochures, flyers, website content, and other marketing materials.

    If you do not wish for your image or that of your child to be used for these purposes, please notify us in writing prior to participating in the program. STEM in the Rockaways respects your privacy and will ensure your preferences are honored.

    By attending, you grant STEM in the Rockaways permission to use these materials for non- commercial purposes aimed at promoting and celebrating our programs.

  • PROGRAM CONSENT

  • Acknowledgment (For Applicants Under 18)

  • Applicant/Parent/Guardian Signature

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