Kidpreneur Camp Form

Parent/Legal Guardian

Full Name

Phone Number

Email Address

Child

Child's Full Name

Date of Birth

Additional Children (Name + DOB for each, if registering siblings) (n/a if not applicable)

Allergies or Dietary Restrictions (please list) (n/a if not applicable)

Medical Concerns or Special Needs (n/a if not applicable)

Emergency Contacts

Emergency Contact 1: Full Name

Emergency Contact 1: Relationship

Emergency Contact 1: Phone Number

Emergency Contact 2: Full Name

Emergency Contact 2: Relationship

Emergency Contact 2: Phone Number

Authorized Pickup Persons (Names + Relationship)

Additional notes from the parent/legal guardian?

I agree to the waiver terms and policies.

I give permission for photos of my child to be used for STEAM Indoor Play Center promotional purposes.

Yes

Signature

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Date

OUR MISSION

For children to reach for the stars in a way that inspires their curiosity, builds their self-esteem, creates an imagination of excitement and to explore all the great wonders of the world.

Kidpreneur Camp Form

Parent/Legal Guardian

Child

Emergency Contacts

OUR MISSION

STEAM Indoor Play Center

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