Summer STEM

Stem 4 All

Register Now Limited Spots Available:
M-F 8am-5pm
7/11/22- 7/22/22
Early registration 125.00 before March 31st
150.00 registration and 150 weekly
Before and aftercare available
DM for early registration link!!

Location:

If other please specify

Name

First NameLast Name

Child's nickname

Sex

Birth date

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Laptop Needed

Current School

Grade entering in the fall of 2022

How did you find out about our program?

Is the child currently taking any medications? If so, please explain.

Does the child have any special needs the staff should be aware of? If so, please explain.

Does the child have allergies? If so, please explain.

Are there any special meal requests? (Food allergies, vegetarian, Gluten-free etc.)

Does the parent anticipate transportation issues during the course of the program? If yes, please explain

Emergency Contact

Emergency Contact #1

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

E-mail

Relationship to child

Emergency Contact #2

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

E-mail

Relationship to child

Pre-Camp Survey

Rows	Strongly Disagree	Disagree	Unsure	Agree	Strongly Agree
Engineering is a "helping" profession (i.e. Nurses, Teachers and Doctors
Engineering is a "creative" profession (i.e. artists and architects
Engineering is a "social" profession (i.e. get to meet lots of people, work a lot with others)
Engineering is a profession that appeals to girls
Engineers make a good salary
Engineers work on lots of social issues (i.e. healthcare, saving environment, etc)
Engineering and technology make our lives better
I am considering a field engineering
I know what engineers do
I enjoy taking math and science courses

What type of engineering are you most interested in at this time(please rank order with 1 being your top choice and 9 being your worse choice)

Rows	1	2	3	4	5	6	7	8	9
Biomedical
Chemical
Computer Science
Computer
Electrical
Material Science
Mechanical
Civil
Environment

What do you expect to get out of the camp?

Are there any engineers related to the child?

Optional Consent

I hereby authorize 2022 STEM 4 All and Hawkins STEM and Robotics; STEM program to publish the photographs taken of the undersigned minor children, and our names, for use in the STEM 4 ALL publications. I release STEM 4 ALL and Hawkins STEM & Robotics from any expectation of confidentiality for the undersigned minor children and attest that I am the parent or legal guardian of the children listed below and that I have the authority to allow STEM 4 ALL/Hawkins STEM & Robotics to use their photographs and names. I acknowledge that since participation in publications and websites produced by Stem 4 All is voluntary, the minor child/(ren) nor I will receive financial compensation. I further agree that participation in any publication and website produced by STEM 4 ALL / Hawkins STEM & Robotics confers no rights of ownership whatsoever. I release STEM 4 ALL/ Hawkins STEM & Robotics its contractors and its employees from liability for any claims by me or any third party in connection with my undersigned minor children. I understand that there are no refunds once I have enrolled my child.

Optional Consent

Signature

Date

"STEM 4 ALL 2022"

Child's Information