Waiting List:

2017 ROE 41 STEM Camp: June 19th - 23rd  / 201 Staunton Road, Troy, IL  62294

Camper Information

Name:*
Birth Date:*
Grade in Fall 2017:*
Home Address:*

Parent/Guardian Information:

Parent 1:

Name: *
Relationship to camper:*
Home Phone:
-
Work Phone:
-
Cell Phone:*
-
E-mail:

Parent 2 (If needed):

Name:
Relationship to camper:
Home Phone:
-
Work Phone:
-
Cell Phone:
-
Alternate Phone:
-
Phone:
-

Campers receive one free Camp T-shirt! Additional t-shirts are $10 each. Please choose a size from the dropdowns below.

Children's Sizes:
Adult Sizes:
By clicking on Submit below you agree to let your child be photographed or videotaped. If you do not agree, type "No" in this box.: