Summer STEM Camp

Required

Student Information

Students First Namerequired

Students Middle Name

Students Last Namerequired

Students Date of Birthrequired

Must contain a date in M/D/YYYY format

Addressrequired

Cityrequired

Staterequired

Ziprequired

Current Middle Schoolrequired

Grade Entering 2025-26required

5th ($500.00)

6th ($500.00)

7th ($500.00)

8th ($500.00)

Grade Entering 2025-26required

5th ($525.00)

6th ($525.00)

7th ($525.00)

8th ($525.00)

Special Considerations

Medical conditions, accommodations, food allergies, concerns, etc.

Household Information

Primary Household - Parent/Guardian 1

First Namerequired

Last Namerequired

Street Addressrequired

Cityrequired

Staterequired

Ziprequired

Primary Household - Parent/Guardian 2

First

Last

Street Address

City

State

Zip

Secondary Household - Parent/Guardian 1

First

Last

Street Address

City

State

Zip

Secondary Household - Parent/Guardian 2

First

Last

Street Address

City

State

Zip

Primary Emergency ContactrequiredWhich parent/guardian is the primary emergency contact for your student?

Primary Household Parent/Guardian 1

Primary Household Parent/Guardian 2

Secondary Household Parent/Guardian 1

Secondary Household Parent/Guardian 2

Other

Which parent/guardian is the primary emergency contact for your student?

Phone Numberrequired

Secondary Emergency ContactWhich parent/guardian is the secondary emergency contact for your student?

Primary Household Parent/Guardian 1

Primary Household Parent/Guardian 2

Secondary Household Parent/Guardian 1

Secondary Household Parent/Guardian 2

Other

Which parent/guardian is the secondary emergency contact for your student?

Other contact info

Name, Address, Phone Number, Email Address

Photo/Video ReleaserequiredI give consent for my child's image to be used in Summer Session promotions.

Yes

I give consent for my child's image to be used in Summer Session promotions.

Payment

Payment Information

Emailrequired

Provide an email address for the receipt.

Please complete captcha below to proceed to payment selection.

Please select a payment typerequired

Credit Card

Billing Addressrequired

Address

City

State/Province

Country

Zip/Postal Code

Cardholder Namerequired

First

Last

Expirationrequired

Month

Year