ScienceWorks Hands-On Museum
Back
LINE

Spring Break Camp 2018 Registration

Registration and full payment must be received by March 23, 2018. 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.

Camp Dates: March 26-30, 2018
Camp Time: 9AM-3PM
Pre-Care: 8-9AM
Post-Care: 3-4PM

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 
* Payment TypeVisa Mastercard 
* 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 
 

Thank you for completing your registration request. After clicking Submit below you will be directed to our payment screen. If you are registering multiple children, click Submit and then return to this form. Once payment has been processed you will receive a confirmation.

 
 
If you have questions regarding the site, please contact the webmaster.
Terms of Use | Site Handcrafted in Ashland, Oregon by Project A, Inc ©2018 | Market Research Powered By QuestionPro

 

Membership Info