M-STEM Event

Muskingum University M-STEM Girl's Summer Camp Registration

June 10 - June 13, 2019
NOTE: REGISTRATIONS ARE DUE BY MAY 13, 2019 or as space permits.
Participant's Name:

First NameLast Name
Date of Birth:

MonthDayYear
Date
Current Grade:
High School:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number:

Area CodePhone Number
Cell Phone Number:

Area CodePhone Number
Email:
example@example.com
T-Shirt Size:

SmallMediumLargeX-LargeXX-Large
Emergency Contact:

First NameLast Name
Relationship to Contact:
Emergency Contact Phone Number:

Area CodePhone Number
ALL REGISTRANTS MUST SIGN THE FOLLOWING:
I release Muskingum University and its agents and employees from any and all claims, demands and causes of action on account of any injury, illness, or loss which may occur during my participation in the 2019 M-STEM Girls’ Summer Camp.
Participant Signature:

Clear
Parent Signature:

Clear
Should be Empty:

Muskingum University M-STEM Girl's Summer Camp Registration