What is your desired Community STEM Club Location?
*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.
Bleecker (325 Bleecker St.)
Capri (7 Capri Rd.)
Chester Le (201 Chester Le Blvd.)
Coatsworth (33 Coatsworth Cres.)
Dan Leckie (150 Dan Leckie Way)
Driftwood (415 Driftwood Ave.)
Erin Court Cooperative Home (1900 North Sheridan Way)
Flemingdon (4 Vendome Place)
Greenbrae (55 Greenbrae Circuit)
Jane and Woolner (190 Woolner)
Knightsbridge (201 Clark Blvd.)
Lawrence and Galloway (4110 Lawrence Ave E.)
Malton Community Centre (3540 Morningstar Dr.)
Mornelle (90 Mornelle Court)
Moss Park (285 Shuter St.)
Neptune (155 Neptune Dr.)
Peel Youth Village (121 Acorn Place)
Queen and Kennedy (9 Ardglen Dr.)
Rexdale (70 John Garland Blvd.)
Rivertown (50 Matilda St.)
Springfield Gardens (3590 Colonial Dr.)
Swansea Mews (21 Windermere Ave.)
Victoria Park (2743 Victoria Park Ave.)
Willowridge (44 Willowridge Rd.)
* Participant Name
Date of Birth
* Date of Birth
Health Card Number (optional)
Please indicate as of program year
Years of participation?
Is your child involved in any other community program(s)?
Child T-shirt size:
Does your child have an allergy?
Do they carry an Epipen or an inhaler?
Race and ethnicity of participant
Please select all that apply- For statistical purposes only.
Aboriginal (First Nations, Métis, Inuit)
South Asian (e.g., Afghan, East Indian, Pakistani, Sri Lankan)
Black (e.g., African, Caribbean, North American)
Southeast Asian (e.g., Filipino)
East Asian (e.g., Korean, Japanese, Chinese, Vietnamese, Cambodian, Malaysian, Laotian)
Middle Eastern (e.g., Iranian, Syrian, Iraqi, Lebanese)
Prefer not to say
Parent/Guardian and Emergency Contact Information
* Parent/Guardian Name
* Cell Phone
Please indicate the best number to contact.
Parent/Guardian highest level of education?
Emergency Contact Name
* Emergency Contact Name
Relation to participant
Emergency Contact Number
* Emergency Contact Number
Home Phone Number
Home Phone Number
Does the participant have any physical disabilities, or special needs?
Media Release and Waivers
Parent/Guardian Signature (Please Type Your Full Name)
Thank you! You will receive a confirmation email with more information once your submitted registration is reviewed and complete. Each club can only accommodate 20 participants each. We prioritize returning students and students who live directly within our target communities. All other participants will be placed on a waitlist until confirmation. For any questions please