STEAM Camp Registration

Child's Name*
First Last
Child Gender*
T-Shirt Size*
Child Date of Birth*
MM slash DD slash YYYY
Grade*
What grade category is your child in? (select only 1)
Program Selection*
What program will your child be most interested in.
Parent/Guardian Name*
First Last
Address*
Street Address City ZIP / Postal Code
Home or Cell Phone #*
Work Phone #
E-Mail Address*
What's the best email address we should use to reach you?
Child's Allergies/Medical Conditions
Medical Release*
I, the parent/guardian of the child listed above, give permission to the VBS leadership to authorize or administer medical attention to my child if they deem it an emergency during VBS Club activities. I understand every effort will be made to contact me first or as quickly as possible. To "sign" this release, please enter your First and Last name in the field here.
In the event of an emergency, please list who we should contact and their phone numbers.*
If we can't get in touch with you or your spouse, please list individuals (and their phone numbers) we should call.
After STEAM Camp, my child may be released to the following people:*
Please enter names below other than mother or father. Enter any special notes.

About Us

We look UP to God, we look INTO His Word, and we look OUT for others.

(305) 751-4955

info@newvisionmiami.com

7321 NE 2nd Avenue Miami,FL 33138 USA