Register Session One

Child's Name *

First

Last

Current Grade Level (2023-2024 school year) *

Birthdate (mm/dd/yyyy) *

Gender *

Girl
Boy

Elementary School Currently Attending

Friend requests

Shirt Size *

Parent/Guardian 1 Name *

Parent/Guardian 1 Email *

Parent/Guardian 1 Phone *

Parent/Guardian 2 Name

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

Any other person authorized to pick up your child:

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Allergies or Medical Conditions (we should know about):

Please note: The cooking class uses wheat, dairy and eggs in the recipes

Photo Authorization- All students will be photographed. Do you authorize STEM Camp to use your child’s image for the purpose of promoting STEM Camp? *

I agree

As the parents or guardians, I release and agree to hold harmless SB STEM Camp, its staff, and Peabody Charter School from any liability for illness or injury while the student is enrolled in the camp and agree to pay for all medical expenses. *

I agree

Typing your name here serves as a signature on the waiver above: *

SB STEM Camp *

Registration Fee - $350.00

Total Amount

$0.00

PayPal Commerce *

Card Number

Expiration Date

Security Code

Card Holder Name

SB STEM Camp – Register Session One