Please enable JavaScript in your browser to complete this form.2021 Science Camp Registration Form Thank you for your interest in Quest Summer Science Camp! Please visit our camp webpage for details before completing this form. This registration form is to be completed by a legal parent or guardian of the participating student to register the same child for single or multiple sessions. Please complete a separate registration form for each student. To ensure your student is fully registered, complete all sections of this form and submit payment by credit or debit card. All registration information submitted will be held confidentially, except in emergency situations that require contact and sharing critical medical information. For more information, refer to our FAQ. Registration is not complete until this form is submitted and payment is received. Contact InformationParent / Guardian Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Double check to make sure this is correct as all future camp communication will be sent to this email.Join the Quest Newsletter to receive updates about future programs and activitiesCell / Home Phone Number *Work Phone NumberHow did you hear about our camp? Check all that apply. *Quest WebsiteQuest NewsletterFlyer/PostcardFriend/RelativeWeb SearchQuest event or activityFarmer's MarketPedrozzi FoundationFacebook AdPatchIndependentPleasanton WeeklyOtherEmergency Contact Information Other than the above adult, provide two OTHER people who are authorized to serve as emergency contacts or will pick up the student.Emergency Contact #1 *FirstLastRelationship *ParentSiblingRelativeFriendCell / Home Phone Number *Work Phone NumberEmergency Contact #2 *FirstLastRelationship *ParentSiblingRelativeFriendCell / Home Phone Number *Work Phone NumberStudent Participant InformationStudent Name *FirstLastGrade in Fall 2021 *678GenderFemaleMaleDecline to stateBirthdate *School(s) Attended in 2020-21 *School Attending in Fall 2021 If DifferentStudent’s T-Shirt Size - a custom camp t-shirt will be provided *Youth XSYouth SYouth MYouth LAdult SAdult MAdult LCamp Selection Select the date, time, and theme for your child’s camp session(s). Only select ones where there is still space as indicated Camp Selection - VOLTS: Lit ElectronsNoneSession 2: June 21-June 25, 1-4 PMSession 3: June 28-July 2, 9-12 PMSession 4: June 28-July 2, 1-4 PMCamp Selection - BOLTS: Mechanical MarvelsNoneSession 5: June 21-June 25, 9-12 PMSession 7: June 28-July 2, 9-12 PMSession 8: June 28-July 2, 1-4 PMI am registering for:One Session - $ 300.00Two Sessions - $ 550.00Safety & Behavioral Expectations We want to create an exciting and positive environment for learning and exploration. To ensure everyone feels safe and respected, we follow these camp rules: Use appropriate language at all times. No teasing or put-downs. Listen to the instructions of the instructors and camp counselors. Respect the materials, equipment, facilities, and the outdoor environment. If there is minor misbehavior, the participant will first be given a warning. If the behavior continues, we will call you to explain the situation and ask you to talk to your child on the phone. Ongoing disrespectful behavior may be cause for dismissal from the program. Additionally, we have a zero tolerance policy for participants who deliberately physically harm other people or damage property. Please review these expectations with your child prior to camp.Safety & Behavioral Expectations *I agree to the safety and behavioral expectations above for my child.Accident & Illness Policy When using tools and equipment, safety procedures will be provided and followed at all times. All accidents will be documented with an incident report. For minor scrapes or cuts, we will provide small bandages. For more serious injuries or medical emergencies or illness, staff will call you or your emergency contacts immediately. Quest Science Center has no health care on-site. You may be required to pick up your child or an ambulance will be called if deemed necessary. If your child is sick, please do not send him or her to camp so we can maintain a healthy environment for other campers. You agree not to hold Quest Science Center or its directors, agents, or staff liable for medical aid rendered in good faith and will be responsible for any medical or other expenses incurred for the care of your child.Accident & Illness Policy *I agree to the accident & illness policy above.Health and Medication PolicyWill your child require prescription medication during camp? If so, please provide the medication name, detailed instructions on usage, dosage/frequency, and time(s).All medication must be provided daily in packaging with the child’s full name and dispensing instructions. Your child will need to store and administer the medication by themselves as staff is not permitted to administer medication. This includes inhalers and EpiPens. By completing this form, you are agreeing to these terms. Does your child have any food or environmental allergies? If so, describe the cause, symptoms, and treatment.Does your child have any restrictions or adaptations that would prevent him/her from participating in any camp activities? Are there any additional conditions or considerations which may affect your camper’s experience during camp? If so, please explain below.Is there any other important information we should know about your child to ensure they have a great experience?This information will be kept on file and on site throughout the duration of the camp for emergency purposes. Information on this form will be shared with staff on a need-to-know basis.Health & Medication Policy *I agree to the health and medication policy above.Photo Release Quest Science Center will be photographing and possibly videotaping camp activities for documentation purposes. High quality photos will also be shared with participating families through a private digital folder. Additionally, photos may be used in future digital and print marketing materials without acknowledgement, compensation, or rights of ownership. Participants will not be identified in all situations. If you do not grant permission, we will exclude your child from the images. Photo Documentation *I grant permission for images of my child to be used for the activities described.I do not grant permission for the images of my child to be used for the activities described. Parent/Guardian Authorization The information submitted in this electronic form is correct and the child described has permission to participate in all camp activities except as noted in the health and medication policy form. I understand that the program will take place at the Bothwell Arts Center and led by the Quest Science Center. It will include science and engineering related activities as well as activities in the park next door. I understand that participation in this event is voluntary. In consideration of being permitted to participate in any way in the above program, I hereby release Quest Science Center and its representatives from liability from any and all claims, resulting in personal injury, accidents or illnesses, and property loss arising from participation in the above program. I agree to the terms and policies above.Your Full Name (typing your name here will be considered a digital signature) *Today's Date *Payment information Quest Summer Camp costs $300 for each half day, weeklong session. There is a discount of $50 if registering for two sessions for the same student. Payment is due at the time of registration in the form of a credit or debit card. Date or time change requests up to seven days before the start of camp will be honored if space is available for a $20 fee. Paid camp fees are transferable to another student up to seven days before the start of camp for a $20 fee. Contact camp@quest-science.org for these requests. Cancellations can be made before May 28, 2021 and are subject to a $50 per session penalty. No refund of fees for camp are available after May 28, 2021 for any reason, including illness. If a student is sick or needs to miss a portion of the week for any reason, those days cannot be made up on a different day.Payment Method *PaypalI am applying for a scholarshipSubmit
