Parents Night Out Registration 3/10/23

Parents Night Out registration and sign up.

Child's Name

First Name

Last Name

Childs Age and Current Grade

Shirt Size

Please list your child's shirt size

Parents Name

First Name

Last Name

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Cell Phone

(###)

###

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Work

(###)

###

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Emergency Contact 1

First Name

Last Name

Phone

(###)

###

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Emergency Contact 2

First Name

Last Name

Phone

(###)

###

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Section

Camper Health History

Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware?

Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of which we need to be aware?

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.

I Accept Terms and Conditions

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

Project STEAM MD

Empowering Students Through STEAM

Empowering Youth Through Science, Technology, Engineering, Art, and Math

Project STEAM MD | 10989 Red Run Blvd suite 108, Owings Mills, United States