Steam Camp Registration Form

DH STEAM CAMP BANNER (1)


    Child’s Name

    Age

    Street Address

    City

    Zip

    Grade Last Completed

    DOB

    Gender

    Current School

    Grade Entering August 2016

    Child’s T-shirt Size
    (please specify sizes)

    Mother’s Name

    Father’s Name

    Legal Gaurdian’s Name

    Daytime Contact Number

    Evening Contact Number

    Mobile Contact Number

    Email Address of Parent

    Allergies/Medications


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