STEAM Summer Camp Registration

"*" indicates required fields

Camper's Current Grade*

Camper Grade for 2023-2024*

Camper Information

Name*

First Name Last Name

Gender*

Date of Birth*

Would you like to register another camper?

Camper 2 Current Grade

Camper 2 Grade for 2023-2024

Name

First Name Last Name

Gender

Date of Birth

Parent Information

Name*

First Name Last Name

Email*

Emergency Contact Number*

How did you hear about Jack & Jill Center's STEAM Summer Camp??*

Media Consent:*

I hereby grant permission for the Jack & Jill Center STEAM Summer Camp to mention, feature or describe my child/children in printed publications, news stories and/or features about the Center and its activities. I further grant permission to use images of my child/children in printed publications, video, social media, press releases and/or the Jack & Jill website without further consideration. I acknowledge that Jack & Jill has the right to crop or treat photographs at its discretion, and understand that Jack & Jill and/or outside agencies may choose not to use the photo at this time, but may do so at its own discretion at a later date.

Field Trip Consent:*

I hearby grant permission for my child/children to participate in STEAM Summer Camp field trips and activities off-campus. I understand that I will be notified in advance of each trip and can opt out on a trip by trip basis.

Full Name of Parent/Guardian Submitting Form:*

Date*

Name

This field is for validation purposes and should be left unchanged.