STEAM Camp Registration 2024

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Please fill out all the information thoroughly for your student so we can plan accordingly!:) STEAM camp will run from June 17th-June 21st from 8:30-12:30 daily at the Watkins Intermediate School. Drop offs can start by 8:15 each morning in the front of the building and pick ups should happen by 12:30 in the same location as drop offs. Snacks will be supplied daily for your student so please include any allergy information/dietary needs in the form below. Water bottles are encouraged daily and student t-shirts will be passed out on the first day of camp!:) Registration for your student will be $100 and that fee includes the weekly activities, two snacks a day and a t-shirt. Registration needs to be paid within 48 hours through E-Z pay (details will be emailed to you once you register). If you have concerns about paying within the given time frame please reach out!:) Please reach out with questions or concerns to: alejeune@laca.org

Email *

Student First Name: *

Student Last Name: *

Student I.D. Number or Lunch code (6 digits)

Student Grade level next year (24-25): *

1st

2nd

3rd

4th

5th

School building that your student attends currently:

Kirkersville Elementary

Pataskala Elementary

Etna Elementary

Watkins Intermediate

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Student Address *

Primary Phone Number: *

List up to TWO emergency contacts with phone numbers: *

In the event of an emergency, our staff will utilize the emergency contact form that is on file, if this is an issue please call to update your forms with your student's building secretary. If the form is up to date please verify your understanding below: *

My student's ER contact form is up to date and can be utilized in the event of an emergency when it comes to medical, dental or other emergency needs.

I will reach out to my student's school building secretary to make changes that are necessary before sending my student to STEAM camp.

Required

Please list any medical concerns, allergy needs and/or dietary restrictions: (Please note if your student has severe food allergies-you are required to supply them with a snack each day) *

Does your student have any educational needs or specifications we should be aware? If not, just put NA please!:) *

Does your student have any behavioral needs or concerns our staff should be aware of? If not, just put NA please!:) *

Student T-shirt size: *

Youth XS

Youth Small

Youth M

Youth L

Youth XL

Adult S

Adult M

Adult L

My student will be dropped off daily at 8:15 am by: (please list any approved person that may be dropping your student off below) *

My student will be picked up daily at 12:30 PM by: (please list any approved person that may be picking your student up-we will be checking i.d.s if need be) *

Registration payment will be submitted within 48 hours through: *

I will pay through E-Z pay once I receive my registration and confirmation email. Please note if payment has not been secured within 48 hours your student's registration will not be valid.

I will pay with cash or check by coming into the District Office at 927 A South Street, Pataskala, 43062.

I have concerns about payment and will reach out to Ashley LeJeune: alejeune@laca.org

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