STEAMcity Registration

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Email *

Camper Name *

Date of Birth *

YYYY

Age as of 6/1/2024 *

Grade as of 09/01/2024 *

Parent or Guardian #1 Name *

Parent or Guardian #1 Cell
*

Parent or Guardian #1 Email
*

Parent or Guardian #2 Name

Parent or Guardian #2 Cell

Parent or Guardian #2 Email

Address *

In case of emergency: Name, relationship, cell # *

Physician's Name, Tel # *

Health/physical issues, special needs, allergies *

T-Shirt Size *

PLEASE NOTE

Applications are accepted on a first-come, first-serve basis. We urge you to register as soon as possible as we have had groups close out in the past. Thank you.

FOR PAYMENT, PLEASE CONTACT ROBYN GAINES AT rgaines@cgps.org.

A copy of your responses will be emailed to the address you provided.

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