2026 KidTek Student Information Form (web advisor)

Student Information Form

Once this form is completed you will be able to move into the registration page.
Student/Child Information
Student Name*

First NameLast Name
Grade completed as of June 2026*
Student Sex*
School District*
Birth Year*
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
Parent/Guardian Information

For Camp Communications
Parent/Guardian Name *

First NameLast Name
Parent/Guardian Phone *
Please include your area code and enter only numeric digits. Example 3197522731Format: 0000000000.
Alternate Phone Number
Primary Email *
example@example.com
Confirm Email *
example@example.com
Emergency Contact

Person responsible for transportation to and from camp
Emergency Contact Name*
Emergency Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number
Relationship to Student*
Does your student have any food allergy, medical, physical or emotional conditions that require special accommodations or require medication on a regular basis? (If no, please type N/A below)*
Photo Agreement
Photos taken during Kidtek U activities may be released to newspapers, posted on SCC bulletin boards, or released for other media and advertising purposes. Photos of my child may be used as stated above.*

YesNo
Photo release special instructions:
Disclaimer Statement
Please review - STUDENT EXPECTATION AND PARENT INFORMATION
I, the parent/guardian of the student listed above, certify that the information provided on this Student Information Form is accurate and complete to the best of my knowledge.

I acknowledge that I have read, understand, and agree to the expectations outlined in the Student/Parent Expectations & Information Sheet.

I understand that signing below constitutes a legal signature confirming my acknowledgment and agreement to the information provided and the expectations referenced above.

For questions, please call 319-208-5375.
Signature of person completing this form*

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Relationship to the Student*
Now it is time to register for camp - press submit to proceed onto the registration screen.

NOTE: Search the camp name in the course code number field or select Kidtek in the topic code dropdown menu.
Should be Empty:

Student Information Form

Student/Child Information

Parent/Guardian Information

Emergency Contact

Photo Agreement

Disclaimer Statement