• 101 Oakland St.
    Trenton, NJ 08618

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Summer Forms for SYEP/ STEM

This field is for validation purposes and should be left unchanged.
Parent/ Guardian First and Last Name(Required)
Your Child's First and Last Name(Required)
Select the program your child is participating in:(Required)
One Call allows Millhill to contact parents to improve ongoing communications. Please provide up to four cell phone numbers to be included in our system.
Allergies (Check all that apply)(Required)
Medical conditions (Check all that apply)(Required)
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In case of emergency, in the event that I nor the emergency contact can be reached, I hereby authorize Millhill to take any action deemed necessary for the best interests of my child, including transportation for emergency room treatment.(Required)
Millhill Child and Family Development will safeguard your protected health information. We will only use medical information in the event of an emergency for the purpose of informing medical personnel.(Required)
By signing below, I give consent for my child to participate in the Millhill STEM Explorers Summer Program, which includes field trips, outdoor walks, and photos/videos of my child participating in STEM program activities which may be used for Millhill's public relations (sign below).
Clear Signature

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