Registration Form

STEM Registration Form

Child’s Information

Allergy Information

I understand it is my responsibility as the parent to provide STEM Summer Camp Staff with an Epi Pen Daily while my child is attending the camp. It is the parent’s daily responsibility to personally hand the EPI Pen directly to STEM Summer Camp staff for safe storage daily, to ensure the safety for all children OR to provide an Epi Pen that will remain on location with STEM Summer Camp Staff for the duration of the summer.

Food Restrictions

Other Important Information

Parent Contact Information #1

(Please list the parent who should be contacted 1st if there is an emergency, or if your child is ill.)

Parent Contact Information #2

Emergency Contact Information

(An Emergency Contact is a 3rd person who can be contacted only in case of an emergency when either parent listed above cannot be reached.)