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Home
Education
//
Camps
//
Health and Consent Form
Camper Information
Camper First Name
*
Camper Last Name
*
Date of Birth
*
Grade Entering this Fall
*
– Select a Grade –
Grades 2 - 3
Grades 4 - 5
Grades 6-8
Grades K-1
Preschool
Gender
*
– Select a Gender –
Male
Female
Address (line 1)
*
Address (line 2)
City
State
– Select a State –
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Dietary and special needs, allergies or medications (please list)
Contacts
Parent/Guardian Name
*
Relationship to Camper
*
Email
*
Phone
*
Emergency Contact
*
Relationship to Camper
*
Phone
*
Physician’s Name
*
Practice Name
*
Phone
*
In case of emergency, the Science Center of Iowa will take your child to Mercy Hospital in Des Moines. If you do
NOT
want them to go to Mercy, where do you want them sent?
Other adults authorized to pick up your camper
Parents must agree to the following to finalize camp registration.
(Optional) Yes
SCI has my permission to take photos of my camper that may be used for marketing purposes. I understand that if I answer no to this question no images will be taken of my camper for any reason.
I understand
that while field trips are not guaranteed as part of camp they are used to support learning. If my camper is scheduled for a field trip they will be driven in a SCI vehicle by camp staff trained to operate this vehicle. If I object to my camper going on a field trip I will not send them to camp on that day.
I understand
SCI Summer Camps are taught by college students or recent graduates that have been studying Education and/or Science.
I understand
SCI campers will be learning about the topic of the camp title. If there is time to explore the rest of the museum, then the camp will do so. Otherwise, the campers will be focused on learning the subject at hand.
I understand
that after May 1 no refunds will be issued for camp without a documented medical reason accompanied by a doctor's note.
I understand
that health forms are good for one calendar year and that should my camper's health information change it is my responsibility to inform SCI by filling out a new health form.
I understand
that SCI is not responsible for personal items my camper brings such as electronic devices, games, cell phones, money, etc.
I am aware
of what time extended care starts and ends (Before Care 7:30 AM - 9:00 AM and After Care 4:00 PM - 5:30 PM) and will drop off and pick up promptly.
I understand
that a $10 fee will be assessed for every 15 minutes that a camper remains after the pick-up time.
I understand
the Science Center of Iowa Camp Program supports Chapter 232 of the Iowa Code and that SCI requires that all employees who are mandatory reporters under this Chapter be familiar with the requirements therein.
Other Information
Please select a size for his/her FREE camp t-shirt!
*
– Select a Size –
Child XS
Child S
Child M
Child L
Child XL
Adult S
Adult M
Adult L
Adult XL
We want your child to have the best possible experience at camp! Please share any information below about your camper that will help us to assist them with a successful day at SCI:
*
I understand and agree
that the above information is correct.
Signature (your name)
*
Education
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Health and Consent Form
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I-CARE
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Home
Get Tickets
Today’s Schedule
Visit
Planning Your Visit
Get Tickets
Hours & Admission
Directions & Parking
Schools & Groups
Permanent Exhibits
Small Discoveries
What On Earth?
When Things Get Moving
Why The Sky?
Makers Studio
Brick by Brick
Planetarium
Seven Wonders
Two Small Pieces of Glass
Violent Universe
Flight Adventures
Phantom of the Universe: The Hunt for Dark Matter
Back to the Moon for Good
Black Holes: The Other Side of Infinity
Global Soundscapes
Iowa Skies Tonight
The Zula Patrol: Under the Weather
Story Time Under the Stars
Solar Odyssey: Journey Through Our Cosmic Neighborhood
Points of Interest
LEGO SCI Model
The Essential Element is You
Feisal Sayeed Sculpture
SCI Parking Ramp
Foucault Pendulum
The Question Mark
Recycling Mini-Exhibit
Movement in C Tharp
A-ha! Store
Traveling Exhibit
Pterosaurs: Flight in the Age of Dinosaurs
Programs + Events
Event Calendar
Youth Programs
Camps
Girls in Science Initiative
Pint Size Science
Innovation Lab Workshops - Youth
Homeschool Programs
Family & All-Ages Programs
Star Parties
Sensory-Friendly Hours
Adult Programs
Mixology
Innovation Lab Workshops - Adult
Special Events
Spooky Science
NOON YEAR'S EVE
Des Moines Mini Maker Faire
Live Programs
Live School Programs
Fire Works
Deep Freeze
Meet Stuffee
Snapping Turtle Feeding
Zap | Sponsored by MidAmerican Energy
Chemistry Clues
Education
Schools
School Visits
Preparing for your Visit
Discovery Labs
Live School Programs
Outreach
Outreach Programs
Nocturnal Science Nights
Homeschool Programs
Camps
Camp Logistics
Join the Team
iEARTH
Partners
Health and Consent Form
SCI Preschool
Professional Development
Educators
I-CARE
Making STEM Connections
Pint Size Science
Scientists
Portal to the Public
SciGirls
Public Learning Resources
SCI Videos
Join + Support
Membership
Gift Memberships
Corporate Memberships
Current Member Resources
Frequently Asked Questions
Volunteer
Support Sci
Donate to Our Mission
Ways to Give
Sponsors & Partners
SCI's Big Blast
Leave a Legacy
About Sci
Contact
Board
Staff
Plan a Private Event
Birthday Parties
Meetings & Events
Weddings
Media Center
News Releases
Logos & Photos
Newsletter Signup
SCI Blog
Employment
Plan an Event
Donate
Contact Us