STEAM Camp Registration 📚🔧🚀

3rd Annual STEAM Camp Registration

Hosted by The Tri-Cities (WA) Chapter of The Links, Incorporated
“All the Parts of Me”

Free Camp for Students in Grades 3 - 8.

Dates:
- April 25 @ Columbia Basin College
- May 2 @ Columbia Basin College
- May 30 - Field Trip to Mobius Discovery Center, Spokane, Way
- June 20 - Visit our Juneteenth Booth for STEAM Activities (Kurtzman Park, Pasco, WA)
Details and required forms to follow.
SPONSORS:
Questions? Phone: 509-308-6374 Email: e-Merge1@outlook.com
Student's Full Name

First NameLast Name
Email Address
example@example.com
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Grade Level
How would you describe your child’s race/ethnicity? (Optional) We collect this information only to better understand who our program is reaching and to support community reporting and outreach efforts. This information is optional and will not affect camp participation.
Student Age
Student Gender
Field Trip Permission
Section 2: Field Trip Permission
Parent Guardian Name

First NameLast Name
Relationship to Student
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Section 3: Emergency Contact
Emergency Contact Name

First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Student
Section 4: Medical & Safety Information
Does your child have any allergies?
If yes, please specify allergies
Does your child have any medical conditions we should know about?
Is your child currently taking medication?
Section 5 Permission & Participation
My child has permission to participate in:
Section 6 Media Release
I give permission for The Tri-Cities (WA) Chapter of The Links, Incorporated to photograph or record my child for educational and promotional purposes related to the STEAM Camp.
Section 7 — Transportation
How will your child travel to camp?
Authorized Pickup Name(s)

First NameLast Name
Section 8 — Parent Agreement
I certify that the information provided is accurate and that my child has permission to participate in the STEAM Camp.
Parent/Guardian Signature
Date

MonthDayYear
Date
Should be Empty:

3rd Annual STEAM Camp Registration

Section 2: Field Trip Permission

Section 3: Emergency Contact

Section 4: Medical & Safety Information

Section 5 Permission & Participation

Section 6 Media Release

Section 7 — Transportation

Section 8 — Parent Agreement