Child's Name *
Child's Name
Please list your child's shirt size
Parents Name *
Parents Name
Home Address *
Home Address
Cell Phone *
Cell Phone
Work *
Work
Emergency Contact 1 *
Emergency Contact 1
Phone *
Phone
Emergency Contact 2 *
Emergency Contact 2
Phone *
Phone
Morning Care
After Care
Section
Camper Health History
Child Physician *
Child Physician
Physician Contact *
Physician Contact
Release Form *
I hereby grant Project STEAM Md. permission to obtain and/or use my child's photograph, video image, or voice for educational, informational, or public relations purposes, with or without identification by name. I understand that all publications, presentations, and productions may be used within the school system and/or the community at large, and that all images, productions, and content therein, become property of Project STEAM Md.

Disclaimer! This program is not affiliated or endorsed with Baltimore County Public Schools.