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Fall 2017 and Winter 2018 Day Camp Registration

Registration and full payment must be received at least one week before camp. Please fill out a separate registration form for each camper. Payment for multiple campers can be submitted on the same payment form. If a camperís registration is canceled at least two weeks prior to the program, a full refund will be issued, minus a $25 processing fee.

Questions? Call 541-482-6767 ext 226 or email camps@scienceworksmuseum.org.

 
* Camper First Name 
* Camper Last Name 
* Birth Date 
* Gender 
* Grade 
* Parent/Guardian Name 
* Home Phone 
* Cell Phone 
* Work Phone 
Parent/Guardian Name 
Home Phone 
Cell Phone 
Work Phone 
* Mailing Address 
* City 
* State 
* Zip Code 
Email 
* Member?Yes No 
* Emergency Contact Name (different than guardians listed above) 
* Emergency Contact Phone 
* Physician Name 
* Physician Phone 
* Important Information (allergies, medical, emotional or special needs). This information will be kept confidential. Please list all information, no matter how minor. It is important that our teachers and staff know of any concerns in order to handle possible situations with ease.  
* I authorize ScienceWorks to photograph and/or videotape my child for publicity purposes (including visits from news media and photos on our website). Yes No 
* Camp SelectionNovember 10: Backyard Oregon
January 26: Dr. Frankenstein's Lab
February 19: Future World
* I have read the ScienceWorks Camps Waiver and Parent Consent Form and agree to all the conditions listed within. Yes 
 

Thank you for completing your registration request. After clicking Submit below you will be directed to our payment screen. Once payment has been processed you will receive a confirmation.

 
 
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