Summer Camp Registration Form

STEMON USA Summer Camp!

We're excited to be offering our first summer camp program! We've provided space to enroll multiple children. If more space is required, please provide their names and birthdays in the space provided.
Student Name*

First NameLast Name
Birthday*

MonthDayYear
Date
Student Name

First NameLast Name
Birthday

MonthDayYear
Date
Student Name

First NameLast Name
Birthday

MonthDayYear
Date
Additional Students
Any additional students, please add their name and birthdate here.
Residence Information
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contacts and Authorized Pick-Ups

Please fill out the following emergency contact information and indicate whether they will be an authorized pick-up for your child.
Primary Contact | Name*

First NameLast Name
Authorized Pick Up?*

YesNo
Primary Contact | Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Primary Contact | Email*
Please enter a valid email.
Secondary Contact | Name

First NameLast Name
Authorized Pick Up?

YesNo
Secondary Contact | Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Contact | Email
Please enter a valid email.
If there are any additional Authorized Pick-ups, please indicate their names and phone numbers here:

Course Selection

Summer Courses*

Morning Session (ages 5-8)

Morning Session Course 1

Course 1 of our curriculum designed for students ages 5-8

$499.00 QuantityChoose Dates
Item subtotal:$0.00

Morning Session Course 2

Course 2 of our curriculum designed for students ages 5-8

$499.00 QuantityChoose Dates
Item subtotal:$0.00

Morning Session Course 3

Course 3 of our curriculum designed for students ages 5-8

$499.00 QuantityChoose Dates
Item subtotal:$0.00

Afternoon Session (ages 9-13)

Afternoon Session Course 1

Course 1 of our curriculum designed for students ages 9-13

$499.00 QuantityChoose Dates
Item subtotal:$0.00

Afternoon Session Course 2

Course 2 of our curriculum designed for students ages 9-13

$499.00 QuantityChoose Dates
Item subtotal:$0.00

Afternoon Session Course 3

Course 3 of our curriculum designed for students ages 9-13

$499.00 QuantityChoose Dates
Item subtotal:$0.00

Enter coupon

Total

$0.00

STEMON USA Policies
Social Media Release
Our center has social media accounts where we share student photos and videos of our activities and projects. Please fill out the following section to indicate whether or not we have your permission for your child being featured on our social media pages.

Instagram: @stemon_usa
Facebook: Stemon USA
Please indicate below:*

Yes, I give my permission for my child's photography/videos to be featured on STEMON social media sites.No, I do not give my permission for my child's photography/videos to be featured on STEMON social media sites.
Please indicate below:*

I understand that my child's photographs/videos will not be used for commercial gain and will not be used for commercial use.
Other Policies
Pick-ups: STEMON USA only offers a half-day schedule for the Summer Camp Program. Pick-up for our morning session is between 12:00 PM - 12:15 PM and will be between 4:00 PM - 4:15 PM for our afternoon session. Late pick-ups are subjected to a $20 fee every 15 minutes.

Break and Snacks: We ask that all students bring a peanut-free snack and a reusable water bottle with them each day. We will have a Break each day, but STEMON will not be providing any refreshments.

Cancellations: All cancellation requests must be made in writing to info@stemonusa.com. Requests made at least 30 days before the start date of your selected camp session will recieve a full refund. Please visit our website at https://www.stemonusa.com/summer-program for more information about our cancellation policy.
Signing your name below will act the same as an electronic signature and acknowledgement of all policies previously stated.

If any information regarding contact information or media release status changes, or if you have additional questions regarding other policies, please let us know via email at info@stemonusa.com.
Name*

First NameLast Name
Date*

MonthDayYear
Date

Payment Methods

Should be Empty:

STEMON USA Summer Camp!

Residence Information

Emergency Contacts and Authorized Pick-Ups

Course Selection

STEMON USA Policies

Social Media Release

Other Policies