Fill in the information below and someone from our staff will be in touch with you.

* Community STEM Clubs are open to everyone in the community however, in line with our mandate, priority is given to children/youth who live directly within our meeting space communities (i.e. youth living in Toronto Community Housing or Peel Living). 

** Please note that our Knightbridge (Clark Blvd PS) Club is over capacity. Any new applicants will be placed on a waitlist or can apply to attend our Queen and Kennedy location**

*Max 20 participants per club. All applications are welcome but priority is given to community members.
Personal
Student Name *
Student Name
Please indicate as of program year
Is this child a returning or first-time student? *
If returning, how many years have you participated? (enter 0 for first time)
How did you hear about this program?
Race and ethnicity of participant *
Please select all that apply- For statistical purposes only.
Parent/Guardian and Emergency Contact Information
Parent/Guardian Name *
Parent/Guardian Name
Phone *
Phone
Please indicate the best number to contact.
Emergency Contact Name *
Emergency Contact Name
Emergency *
Emergency
Residence
Present Health
Does the participant have any physical disabilities, allergies, food restrictions, or special needs? Does your child carry an Epipen or asthma inhaler? If none indicate N/A.
Other
Parent Volunteer Opportunity
Please contact me!
Media Release and Waivers
Photography/Media Release *
Liability Waiver *
Consent
Consent *