EmailMe Form - 2023 Middle School Summer STEM Camp

Child's grade

This camp is only intended for incoming 5th and 6th graders.

Child's Name *

First Last

Gender *

Male

Female

Child's Birthday *

MM / DD / YYYY

Parent/Guardian #1 *

First Last

Parent/Guardian #1 Relationship to Camper *

Parent/Guardian #1 Cell *

### - ### - ####

Parent/Guardian #1 Work Phone

### - ### - ####

Parent/Guardian #1 Place of Business *

Parent/Guardian #1 Email *

Is there a second Parent/Guardian to add?

Yes

No

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