Student Information

Child's First Name *

Last Name *

Address 1 *

Address 2

Phone

Parent's Email Address

City *

State *

Zip Code *

How old is your child? *

4-5

6-8

9-12

13-15

School Information

School *

City *

State *

Why do you want your child to attend SciTech Kids summer camp? Why do you require a scholarship? *

Which week or weeks is your child available to attend SciTech Kids? *

August 1

August 8

August 15

August 22

Please list any sports, extracurricular, or community service activities your child has participated in.

Thank you for submitting this application. We will respond within 24 hours for those interested in August 1. Is there anything else you would like to share about your child?

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