STEM & Robotics Daze
Scan to register for the student summer camp and prepare necessary details.
Student Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Session Location
Please Select
7/7/26 Shawnee Community College Main Campus - Ullin
7/9/26 Alexander County Extension Center - Cairo
7/28/26 Massac County Extension Center - Metropolis
TBD - Johnson County Extension Center
School Name
*
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Allergies
Register
Should be Empty: