Interest Questionnaire for BASE Youth Arts and Cultural Immersion & S.T.E.A.M. Summer Camp

Participant Information

Name of Parent/Guardian:

Phone

Email

Number of Children Interested:

Grades of Children Attending for School Year (2025-2026) - (Check all that apply):

Program Commitment

Are you interested in enrolling your child(ren) in the 8-week camp during June and July?

Yes

No

Would your child(ren) be able to attend the full 8-week program?

Yes

No

Which session(s) are you available for?

Session 1: June 2025

Session 2: July 2025

Both

Drop-Off and Pick-Up

Would your family need early drop-off (6:30 AM - 8:00 AM)?

Yes

No

Would your family need late pick-up (3:00 PM - 6:00 PM)?

Yes

No

Cost and Scholarship

Would you be able to afford $25 per week for the program?

Yes

No

Would you need a scholarship to cover the cost of the program?

Yes, Full Scholarship

Yes, Partial Scholarship

No

If you answered Yes, to needing a scholarship. Please explain your circumstances.

Program Excitement

What excites YOU most about the camp’s focus on S.T.E.A.M. (Science, Technology, Engineering, Arts, and Mathematics)?

What specific activities would your child(ren) be most excited to participate in? (Check all that apply)

Building and exploring STEM kits

Creating art projects inspired by African cultures

Listening to and discussing myths and fairytales from around the African Diaspora

Writing and sharing personal stories using positive affirmations

Learning about wildlife and conservation

What cultural aspects are you most excited for your child(ren) to explore during camp? (Check all that apply):

African geography and landmarks

Wildlife and ecosystems

Stories and traditions from various African and Diaspora cultures

Art and creative expression inspired by cultural themes

Does your child(ren) have any prior exposure to or interest in any of the following?

Science (e.g., nature, wildlife)

Technology (e.g., gadgets, coding)

Engineering (e.g., building, problem-solving)

Arts (e.g., drawing, storytelling)

Mathematics (e.g., puzzles, patterns):

If you selected one of the areas of exposure above, please provide a few details:

Additional Information

Do you have any additional feedback, suggestions, or questions about the camp?

Thank You for Your Input!

We will notify you once registration for the summer camp opnes. Your responses will help us shape an engaging, enriching, and educational experience for all participants. We look forward to connecting with you and your family!