2022 Summer STEM Student Registration

Claysburg Education Foundation

T-Shirt Size *

Street Address *

Email: *

City, State & Zip Code *

Emergency Contact #1 Phone Number *

I give authorization to the Claysburg Education Foundation & the Claysburg-Kimmel School District to photograph my child and use any photo and/or video for publishing via local news publications, CKSD or Claysburg Education Foundation website or social media platforms. *

Yes

Student's Name *

Emergency Contact Name #1 *

Emergency Contact Name #2 *

Registration for 2022 Summer STEM & The Arts

Limited Seats!

Only $25 to Register!

Last Day to Register-May 4, 2022

*Updated Registration Deadline*
Any eligible CK or local students from neighboring districts: May 24th

Parent/Guardian Name *

PAYMENTS:
You can make a payment for each registration by clicking 'Buy Now' below. If you wish to pay with a Debit/Credit Card, first login to Paypal. Under the 'Pay With' section you can add a credit/debit card and then select the card.

Comments/Questions:

School District *

Emergency Contact #2 Phone Number *

Please List Any Allergies or Medical Issues we should be aware of. If none, enter None *

To ensure this is a beneficial and worthwhile experience as well as to maintain the safety of all students attending Summer STEM & The Arts, if a student is found to be engaging in horseplay, being a distraction to others, not following directions, or otherwise endangering themselves or another student their parent or guardian will be immediately notified and the student will be removed from the program. *

I have read the above statement, understand and agree.

Grade entering for 2022-23 School Year *

Parent/Guardian Phone Number

Phone: 814-239-2901

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