Teen Stem Club Registration Form

Registration Form

Please read the information below carefully.
Thank you for your interest in our Summer Stem Club for Teens! This information helps us create a safe, supportive, and enjoyable experience for all participants.
Please note that this program is designed for teens ages 14-18. Participants should be able to participate in a small group setting with approximately 5-6 other teens and one support worker. Our staff are committed to creating an inclusive and supportive environment and will use the information provided below to help your teen have a positive experience.
Participant Information

First NameLast Name
Birth Date

MonthDayYear
Preferred Pronouns
Parent/Guardian Information

First NameLast Name
E-mail
example@example.com
Mobile Number
Format: (000) 000-0000.
Emergency Contact
Emergency Contact 1

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Participant
Emergency Contact 2

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Participant
Previous Participation
Has your teen participated in a program, camp, club or extracurricular activity with us before?
If yes, please specify.
Supporting Your Teen

To help us provide a positive experience, please share any information that would be helpful for our staff to know.
Are there any situations, environments, or experiences that may be challenging or upsetting for your teen?
If your teen becomes overwhelmed, stressed, or dysregulated, what strategies or supports work well for them?
How can our staff best support your teen during sessions?
Additional Information: Is there anything else you would like us to know about your teen to help them have a successful experience?
Has your teen ever had any behaviour concerns? (For example, aggression towards themselves or others, property destruction or running away.)
If you answered yes, please identify and describe the behaviour. (Ie. Which setting does it occur in? What typically triggers the behaviour? How long does it last? How often does it occur?)
Once submitted, we will review your application and contact you to confirm whether or not the registration has been approved.
Should be Empty:

Registration Form

Thank you for your interest in our Summer Stem Club for Teens! This information helps us create a safe, supportive, and enjoyable experience for all participants.

Emergency Contact

Previous Participation

Supporting Your Teen

Once submitted, we will review your application and contact you to confirm whether or not the registration has been approved.