Summer Cohort Sign-Up Form | STEM Unique

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S.T.E.M. Cohort Sign-Up Form

We're excited for an immersive learning experience where students will be exposed to amazing S.T.E.M. careers! Complete one form (per child) to reserve their spot for our services. If you have any questions, connect with us at contact@stemunique.org.

Adult's Full Name*

Phone Number*

Email*

Child's Full Name*

Child's Grade Level*

Child's Food Allergies/ Restrictions*

How did you hear about us*

Website

Social Media

Internet Search

Flyer

Friend

Family

School

Other

I consent to my child's photo/video being used for promotional, educational, or informational purposes. I also release STEM Unique, Inc from any liability for injuries that may occur during participation.

Yes

No

Empower

Empowering Youth Through S.T.E.M. Exposure

Connect

Inspire

contact@stemunique.org

Your Email Address

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