Health and Consent Form

Camper Information

Camper First Name *

Camper Last Name *

Date of Birth *

Grade Entering this Fall *

Gender *

Address (line 1) *

Address (line 2)

City

State

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

Please select all of the camps your child will be attending from the list below.

Grades 1–2

			Members	Non-Members

Aug2 – 6	AM	SUNsational Science	$110	$135	× SUNsational Science (Grades 1-2) Ever wonder what makes the weather change? Step into the shoes of a meteorologist as we explore the science behind the weather! Register for this Camp
	PM	Shooting Stars	$110	$135	× Shooting Stars (Grades 1-2) Blast off into this out-of-this-world camp! Discover the different planets of our solar system and gaze into the universe beyond. Experience the Star Theater planetarium, and name your very own constellations. Register for this Camp
	Full Day		$220	$270

Aug9 – 13	AM	Play With Your Food	$110	$135	× Play with Your Food (Grades 1-2) Who knew you could do so much with food BESIDES eat it? Foods will become our tools, building materials and much more! Register for this Camp
	PM	Over the Rainbow	$110	$135	× Over the Rainbow (Grades 1-2) What makes a rainbow? How do we know when it’s going to rain? Learn about the water cycle, light, shadows and weather in this camp for future meteorologists. Register for this Camp STEM Learning Goals: Develop an understanding of the water cycle and basic weather patterns. Gain knowledge of how colors and rainbows are formed.
	Full Day		$220	$270

Grades 3–4

			Members	Non-Members

Aug2 – 6

All Day

$220

$270

Aug2 – 6

All Day

$220

$270

Aug9 – 13

All Day

$220

$270

Grades 5–8

			Members	Non-Members

Aug2 – 6

All Day

$220

$270

Aug2 – 6

All Day

$220

$270

Aug9 – 13

All Day

$220

$270

Pre-K–Kindergarten

			Members	Non-Members

Aug2 – 6	AM	Once Upon a STEM	$110	$135	× Once Upon a STEM (Grades Pre-K - K) Rewrite your favorite fairytales using science, technology, engineering and math. Help your favorite storybook characters find solutions to their problems! Register for this Camp (June 7-11) Register for this Camp (August 2-6)
	PM	Tinker Time	$110	$135	× Tinker Time (Grades Pre-K - K) Let your imagination run wild in this camp designed around creativity! We’ll use tools and learn techniques to take your tinkering to the next level. Register for this Camp
	Full Day		$220	$270

Aug9 – 13	AM	Bits, Bots and Watts	$105	$130	× Bits, Bots and Watts (Grades Pre-K - K) Beep, beep, boop! Explore the world of coding and the basics of electricity while building your own robot in this technology-focused camp. Register for this Camp
	PM	Make a Mess	$110	$135	× Make a Mess (Grades Pre-K - K) Who doesn’t love making a mess? We’ll get messy as we explore the three states of matter: solids, liquids and gases. (Parents, don’t worry: we’ll handle the clean-up!) Register for this Camp (June 7-11) Register for this Camp (August 9-13)
	Full Day		$220	$270

Parents must agree to the following to finalize camp registration.

I understand photographs may be taken of my camper for future SCI marketing purposes, and I give consent for my camper's photos to be used.

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 refund requests made at least two weeks prior to each session's start date will be granted, minus a $60 cancellation fee for full-day camp and $30 for half-day. With less than two weeks' notice, refunds will not be granted, but credit may be used for other camps during the same season.

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 the camp's starting and ending times (AM Camp 9:00 AM – 12:00 PM and PM Camp 1:00 PM – 4:00 PM) and will drop off and pick up promptly. I realize that if my child arrives late, they may miss their fieldtrip and will be placed with another camp for that day.

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 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.

(Optional) Yes, My child is in 5th-8th grade and can sign themself in and out of camp.

Please indicate where your camper is to wait for you for pick-up. For those 5th-8th graders allowed to sign themselves out of camp, they must go directly to the designated pick-up location listed below. They are not allowed to explore SCI after camp unless accompanied by an adult. *

Other Information

Yes, my child is attending a full-day of camp.

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) *

Age	Non-Members	Members
Child (2–12)	$11.00	FREE
Adults (13–64)	$11.00	FREE
Senior (65+)	$10.00	FREE

Health and Consent Form

Camper Information

Contacts

Please select all of the camps your child will be attending from the list below.

Grades 1–2

SUNsational Science (Grades 1-2)

Shooting Stars (Grades 1-2)

Play with Your Food (Grades 1-2)

Over the Rainbow (Grades 1-2)

Grades 3–4

SciGirls: Create (Grades 3-4)

Space Out! (Grades 3-4)

Shipwrecked (Grades 3-4)

Grades 5–8

Intergalactic Vacation (Grades 5-8)

iEARTH (Grades 5-8)

SCI Film Festival (Grades 5-8)

Pre-K–Kindergarten

Once Upon a STEM (Grades Pre-K - K)

Tinker Time (Grades Pre-K - K)

Bits, Bots and Watts (Grades Pre-K - K)

Make a Mess (Grades Pre-K - K)

Parents must agree to the following to finalize camp registration.

Other Information

Education