2017 STEM Day Camp

STEM day camp
* required information
Registration 
Registration Information
Youth Participants (First and Last Name):*
T-shirt Sizes:*
DOB::*
Male/Female:* Male
Female
Custody Agreement:*
Medications and/or Allergies:
First Name:*
Last Name:*
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:*
How did you hear about us?:
Additional Youth Names & Ages:
Additional Participant T-shirt Sizes (YS - AL):
Emergency Contact #1:*
Emergency Contact #1 Phone:*
Emergency Contact #2:
Emergency Contact #2 Phone:
Adults Authorized to Pick Up:*
Fees
Week 1: July 10 - 14, 2017:
Youth registration, week 1
@ $250.00 = $
  We have reached the maximum number of registrations for this registration type.
Week 2: July 17 - 21, 2017:
Youth registration, week 2
@ $250.00 = $
Discount
If you have received a discount code, please enter it here: