2026 STEM Summer Camp
All-Inclusive Residence Experience at the University of Waterloo co-facilitated with Waterloo District Catholic School Board
Student's Information
Member ID
Student Name
*
Nickname
Date of Birth
*
-
Year
-
Month
Day
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Age
Entering Grade in September 2026
*
Please Select
10
11
12
Nationality
*
Do you require a Canadian visitor visa?
*
Yes
No
Other
Upload Bio Page of Passport
*
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Parents' Information
Parent/Guardian 1
Parent/Guardian 1
*
First Name
Last Name
Relationship to Child
*
E-mail
*
example@example.com
Cell Phone
*
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parents' Information
Parent/Guardian 2
Parent/Guardian 2
First Name
Last Name
Relationship to Child
E-mail
example@example.com
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Home Address Same as Parent/Guardian 1?
Yes
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Emergency Contacts
Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you.
Full Name (Emergency Contact #1)
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
*
example@example.com
Primary Phone Number
*
Format: (000) 000-0000.
Relationship to Child
*
Full Name (Emergency Contact #2)
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address
example@example.com
Primary Phone Number
Format: (000) 000-0000.
Relationship to Child
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Medical / Health Information
Does your child have any food, medication or environmental allergies?
*
Yes
No
Allergies? Check all that apply
Food
Medication
Environmental
Please list and explain any allergies
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Does your child have a special health or medical condition? If yes, please contact Inspire2Canada@gmail.com before completing this registration form.
*
Yes
No
Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?
*
Yes
No
Please explain
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Payment and Statement of Understanding
Payment Method
Please be advised that an invoice outlining the applicable payment method will be issued within 24–72 hours after submission of this form.
Payment Method
*
Credit Card (+4% credit card transaction fee)
E-transfer (to: inspire2canada@gmail.com)
Wire Transfer
EFT Transfer
Who is completing this form?
*
Parent/Guardian
Student
Agent Representative
Other
Name of Person Completing this Form
*
First Name
Last Name
Sign Document
*
Date Signed
*
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Month
-
Day
Year
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SUBMIT
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