Register for Neptune STEAMPark

Register below for STEAMpark Daily After School Enrichment Program at The Campus at Macedonia, 1924 Hecht Ave., Neptune, NJ:

Once Registration is complete, click here to make a payment or click her to pay by CashApp

Student's Name

First Name

Last Name

Grade

Birthdate

YYYY

School Name & Town

Email Address

Student's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian's Name

First Name

Last Name

Any special custody arrangements we should be aware of ?

Parent or Guardian's Phone Number

(###)

###

####

Student Allergies/Medical Conditions we should be aware of ?

Please list any allergies or medical conditions we need to be aware of (enter N/A if not applicable)

Any special learning accomodations in schol (504, IEP etc)?

Emergency Contact Name

First Name

Last Name

Relationship to student

Emergency Contact Primary Phone

(###)

###

####

Emergency Contact Alternate Phone

(###)

###

####

Who else does student live with ? Please list everyone in the house including siblings

First Name

Last Name

Relationship to Student

Name

First Name

Last Name

Relationship to Student

Note:

I give permission for my child to be photographed and recorded by staff members participating in the program. I verify that I know media may be used at the discretion of STEAMpark, INC for creating photo memories for my child and me, enhancing the learning experience, sharing successes with the community, and promoting the program in general. Funding for the STEAMpark Academy After-School program requires that statistical information for participating students is collected and reported. In addition, each student is supported based on his or her academic level and needs so that individual performance goals can be met in accordance with and support of the student’s sending school and district. Evaluators keep all information strictly confidential. With my signature on this form, I acknowledge and give my consent.

Parent/Guardian Name

First Name

Last Name

Date

YYYY

Your registration is not complete until you hit "submit."

After completing registration, click here to make a payment.