2026 STEM LEAPS Summer Learning Lab Registration Form

City of Riverside Fire & Police Department

07/13/2026 - 07/17/2026
9:00am to 4:00pm

ELIGIBILITY: STUDENTS MUST LIVE OR ATTEND HIGH SCHOOL (PUBLIC, PRIVATE OR HOME SCHOOL) IN THE CITY OF RIVERSIDE AND HAVE COMPLETED THE 9TH GRADE.

YOU WILL BE REQUIRED TO PROVIDE YOUR OWN TRANSPORTATION AND MUST ATTEND ALL 5 DAYS TO COMPLETE THE PROGRAM.

REGISTRATION WILL BE LIMITED TO 60 STUDENTS.

PARENT/LEGAL GUARDIAN SIGNED WAIVER/ CONSENT FORMS WILL BE REQURED

PROGRAM WILL INCLUDE CLASSROOM AND PHYSICAL PARTICIPATION

Students will be required to follow a code of conduct, failure to do so will result in being removed from the program. We will also conform to prevailing public health guidance and assure the safety of all.

You will receive updates and information about the programs. If you find that you are no longer able to participate, please let us know as soon as possible.

*Required fields

Student Email (please use an alternate email you can access out of school)

Confirm email

Student Last Name

Student First Name

Student Date of Birth

Student Phone Number

Parent/Legal Guardian Email

Parent/Legal Guardian Last Name

Parent/Legal Guardian First Name

Parent/Legal Guardian Phone Number

Address

City/Town

State/Province

ZIP/Postal Code

Student's School of Attendance

Student Grade Academic Year 2025/2026

Do you have access to the internet at home and a Chromebook or iPad?

Yes

Please check your email for waiver/permission slip that will need to be signed and returned prior to the start of the program by a Parent/Legal Guardian to secure a seat.

REGISTRATION WILL CLOSE ON JUNE 26, 2026.

For questions contact:

Gina Perez
[email protected]
(951) 826-5334
Fire Public Education Coordinator
City of Riverside Fire Department

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Please note that submitting a registration form does not guarantee acceptance into the program. All applications will be reviewed to determine eligibility. If your applicant is selected to participate, you will receive a follow-up email with a permission slip and waiver that must be completed, signed, and returned