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

* Community STEM Clubs are open to all children and youth from 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). 


Commitment

Due to the costs associated with ensuring that this program remains free we take attendance seriously and require participants to commit to their weekly workshops. To remain in the program, participants must not miss more than 30% of the workshops per term

*Max 20 participants per club. All applications are welcome but priority is given to youth who live directly in the communities where clubs are held.
Participant Information
Participant Name *
Participant Name
Date of Birth *
Date of Birth
Please indicate as of program year
Is this child a returning or first-time student? *
How did you hear about this program? *
Please check all that apply
Other
Program Name
Other
Dietary Restrictions *
Other
Explain
Race and ethnicity of participant *
Please select all that apply- For statistical purposes only.
Not listed (please specify)
Parent/Guardian and Emergency Contact Information
Parent/Guardian Name *
Parent/Guardian Name
Cell Phone *
Cell Phone
Please indicate the best number to contact.
Business Phone
Business Phone
Other
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Number *
Emergency Contact Number
Residence
Home Phone Number
Home Phone Number
Medical Information
Explain
Parent Volunteer
Please contact me!
Media Release and Waivers
Photography/Media Release *
Evaluation Consent *
Liability Waiver *
Consent
Consent *