Summer STEM Mania Camp Registration Form

Summer STEM Mania Camp Registration Form
Camper's Information
Was this camp purchased through Groupon?

YesNo
Child Last Name*
Child First Name*
Gender*

MaleFemale
Birth Date*

MonthDayYear
Grade entering in the fall*
Name of School
Other Information
First Time Camper?*

YesNo
How did you hear about Summer Camp at The STEM Lab?
Personal Information
Phone Number

Area CodePhone Number
Address*
City*
State*
Zip*
"STEAM Your Way" Summer Camps @ Sharonvillle location

Select all that apply. Payment is not required until June 15, 2020. However in order to reserve space now, a $30 nonrefundable registration fee is due. This amount will come off the regular price of the camp (i.e. not the early bird price).
Full Day Camps at The STEM Lab in Sharonville, Ohio. Please select a camp week. Early bird price is first. Payable between April 1 - May 1.

June 29 - July 3 Extreme Engineering $175July 6 - 10 "Girls Who STEAM" $120July 13 - 17 "Dinosaur Discoveries" $175July 20 - 24 "Harry Potter STEAM Wizards" $175July 27 - 31 "Electrifying Engineering" $175August 3 - 7 "Wonka Candy Camp" $175
Off-site "STEAM Your Way" Summer Camps

Select all that apply. The website below is where you can send payment. You do NOT need to pay the $30 registration fee to hold your space.
Off-site STEM/STEAM Camps facilitated by The STEM Lab.

June 15 - 19 @ Kids First Sports Center in Blue Ash. "Slime Science" 9a – 12p (for rising KG – 2) $225 *Register online with Kids First Sports Center at https://www.kidsfirstcamp.comJune 15 - 19 @ Kids First Sports Center in Blue Ash. "Slime Science" 1p – 4p (for rising 3 - 7) $225 *Register online with Kids First Sports Center at https://www.kidsfirstcamp.comJune 22 - 26 @ Kids First Sports Center in Blue Ash. "Snacking on Science 9a – 12p (for rising KG – 2) $225 *Register online with Kids First Sports Center at https://www.kidsfirstcamp.comJune 22 - 26 @ Kids First Sports Center in Blue Ash. "Snacking on Science 1p – 4p (for rising 3 - 7) $225 *Register online with Kids First Sports Center at https://www.kidsfirstcamp.com
Before and After Care Needs available only for full-day camps. 8a -9a, 2p - 4p, or 4p - 5p.

Before Care $10/hrAfter Care $10/hrOne childMultiple children
Parent or Legal Guardian Information
Type a question
Parent/Legal Guardian*
Relation*
Work Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Parent /Legal Guardian 2*
Relation 2*
Work Phone 2*

Area CodePhone Number
Cell Phone 2

Area CodePhone Number
Home Phone*

Area CodePhone Number
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not avaliable)*
Emergency Number*

Area CodePhone Number
Emergency Number #2*

Area CodePhone Number
Email Confirmation
Parents Email (camper confirmation will be sent by email)
Health Information

A health officer is not on site, although all staff is first aid certified.
Are immunizations up to date?

YesNo
Any activity the camper should be restricted from?
Any physical, mental or other condition that would require special attention or medication while at camp?
List all medications and times to be given, during camp. All medications will be turned into the staff manager.
List any allergies (ex: bees,peanuts, dairy)
Any dietary needs that we should know about?
Acknowledgments
- Be certain to enter your email address correctly on the registration form to receive confirmation via email with in 2 weeks
I understand there is no refund unless The STEM Lab cancels a camp.

Yes, I understand
PHOTO RELEASE I hereby give permission for my child to be photographed during the STEM Lab Summer STEM Mania Camps. I understand the photos will be used to keep a journal of activities, to share during power point presentations and/or reports to our donors and for promotional purposes including flyers, brochures, newspaper and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of The STEM Lab.

YesNo
The STEM Lab and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders. Children's’ photos and quotes may be used for publicity purposes. In case of an emergency, and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician).

Yes, I understand
I understand that The STEM Lab or its Summer STEM Mania Camp will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian.

Yes, I understand
BEHAVIOR: The same behavioral expectations the schools have are what we expect. Please have this conversation with your child. Discipline policy:Two verbal warnings will be communicated about behavior. If poor or unsafe behavior choices continue a call to parents will be made and the child must be picked up. Scholar will be allowed to attend the following day, however if any more warnings occur they will be asked to leave and not return. The same personal and community safety basics apply here as they do at school along with no bullying tolerance. It is very important that behavior is safe, responsible, and respectful because children will be around and using expensive and potentially unsafe tools.

Yes, I understand this behavior policy
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. The camp carries secondary insurance. I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites.
Electronic signature*
Thank you for completing your child's summer registration form with The STEM Lab. An electronic payment request will be emailed within 24 hours of this submission. To reserve your child's spot, the payment must be made within 48 hours of receiving the electronic payment.
Should be Empty:

Summer STEM Mania Camp Registration Form

Camper's Information

Other Information

Personal Information

"STEAM Your Way" Summer Camps @ Sharonvillle location

Off-site "STEAM Your Way" Summer Camps

Parent or Legal Guardian Information

Emergency Contact Info

Email Confirmation

Health Information

Acknowledgments