Child's Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Has the child previously attended STREAM Camp?

Yes

No

Scholarship

Are you interesting in applying for a scholarship?

Yes, please contact the school principal to confirm my eligibility for a scholarship .

No

Parent/Guardian's Name *

First Name

Last Name

Phone (Day) *

(###)

###

####

Phone (Evening)

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country