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Fun With Engineering Camp July 16th and 17th, 2018 Application Form

 

Name _______________________________________________________________________
Home Address ________________________________________________________________

City __________________________________ State __________________ Zip____________

Telephone No. (Home) ________________________ Grade Level ______________________

Why do you want to attend Fun with Engineering Camp 2018? _____________________________

____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Parent/Guardian Name: ____________________________ Phone number _________________
E-mail ________________________________________________________________________
Emergency phone number ________________________ Name of contact __________________

Name of Family Doctor: ________________________ Phone number: ____________________

Allergies/medications taken: _______________________________________________________

Other medical information: ________________________________________________________

Please call Elizabeth Strong at (304) 23-DINOS or e-mail This email address is being protected from spambots. You need JavaScript enabled to view it. if you have any questions.

Please fill out form completely and mail to:
Libby Strong
SMART-Center
30 22nd Street
Wheeling, WV 26003
Applications are due by July 14th, 2018