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Future King's STEM Summer Camp Registration Form
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* Indicates required question
Camper Intormation
What camp(s) are you attending?
*
Aviation Engineering July 26 - July 30 (Manassas)
Required
Name
*
Your answer
Address (to include State and Zip)
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Age
*
Your answer
Entering Grade
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Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Gender
*
Female
Male
Prefer not to say
Other:
Citizenship - This question is required for the Aviation field trip
*
US
Permanent Resident
Neither
Are you a member of Future Kings
*
Yes
No
Did you come as an individual or with a group?
*
Individual
Group
If you are coming with a group, what is the name of your group?
Your answer
Parent/Guardian
Parent/ Guardian Name
*
Your answer
Home Phone
*
Your answer
Mother's Daytime Phone
*
Your answer
Mother's Cell Phone
*
Your answer
Father's Cell Phone
*
Your answer
Father's Daytime Phone
*
Your answer
Health/Medical Problems
*
Your answer
Drug/Food/Other Allergies
*
Your answer
Last Tetanus
*
MM
/
DD
/
YYYY
Regular Medications
Your answer
Special Diet Needs
Your answer
Family Doctor
*
Your answer
Family Doctor Phone Number
*
Your answer
Insurance Name
*
Your answer
Insurance Name Phone Number
*
Your answer
Policy Holder
*
Your answer
Birthdate of Policy Holder
*
MM
/
DD
/
YYYY
Policy Number
*
Your answer
Name of person responsible for payment
*
Your answer
Email of person responsible for payment
*
Your answer
Phone number of person responsible for payment
*
Your answer
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