Young CEO's Sign Up

First name (Parent/Guardian)

Last name (Parent/Guardian)

Relationship to child?

Phone

Address

Name of your young CEO (First & Last)

Age?

Grade Level?

Date of Birth?

Emergency contact information? (Please include he following: Emergency Contact Name, Relationship to Child, Phone Number)

Does your child have any allergies? (food, medication, environmental)

Does your child have any medical conditions we should know about?

Does your child take any medications during camp hours?

Are there any physical, behavioral, or learning needs we should be aware of to help your child succeed?

Is your child authorized to receive basic first aid if needed?

Please explain if you answered YES to any of the questions.

Has your child attended a STEM, coding, math, or entrepreneurship camp before?

Does your child have access to a laptop?

Does your child have experience using:

Do you give permission for your child to participate in all camp activities?

Do you authorize camp staff to seek emergency medical treatment if you cannot be reached?

May photos/videos of your child be used for camp marketing and social media?

Do you have any questions or concerns you'd like us to know about?

I certify that the information provided is accurate. I understand the nature of camp activities and give permission for my child to participate. I agree to the camp policies and code of conduct.