STEAM Camp Application

Chicago Urban League 2019 STEAM Camp Application
Camp Description:

The Chicago Urban League STEAM Camp is a FREE STEAM (Science, Technology, Engineering, Arts, Math) Camp for middle school students entering 6th grade through graduating 8th grade. The camp will run from July 29th 2019-August 10th 2019. From 10:00 am-4:00 p.m

Students participating in the camp will:

-Go on field trips

-Recieve free t-shirts

-Recieve an incentive for completing the camp

And most of all, will be able to have fun, learn, and make new friends!!
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Name of School*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
T-Shirt Size (Adult)
Participant in Project Ready Middle School
Will your child need transportation from the Chicago Urban League (4510 S. Michigan) to the camp site at 2150 S. Canalport
Demographic Profile
Age
Race/Ethnicity
Gender
What area of STEAM do you find the most interesting?

ScienceTechnologyEngineeringMathArts
What area of STEAM do you find the least interesting?

ScienceTechnologyEngineeringMathArts
Did you participate in Chicago Urban League's STEM camp last year?
Is your child currently taking medication?
If so what kind?
Does your child have any allergies or medical conditions?
If so please; please explain.

Student Interest

Please have your child complete this portion of the application
Please explain why you would like to be part of the Chicago Urban League STEAM camp
What do you hope to learn at STEAM camp?
Program Participation

July 29th - August 9th 10:00-3:00
Are there any projected days that your child will be absent from the program?
If so, please enter the dates
Are there any anticipated days that your child will need toarrive late or leave early?
If so please enter the dates?
Is your child participating in any other summer programs?
If yes, please list the name of the program.

Emergency Contact Information
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
By signing below I am confirming that all information entered is accurate and up to date. I am consenting that my child will participate in the full two week program.
Signature

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Chicago Urban League 2019 STEAM Camp Application