STEAM Camp Registration Form | Michigan Maritime Museum

STEAM Kids Summer Camp Registration Form

Parent/Guardian Name*

First Last

Email

Phone*

Mobile
Work
Home

Are you a Museum Member?*

We are Museum Members
We are not Museum Members

Student Name*

First Last

Age*

Grade Level*

3rd
4th
5th

T-Shirt Size*

Each student will receive a camp t-shirt. Please select from the size options below.

Small
Medium
Large
X-Large

Are there any medical conditions of which we should be aware? Please describe.

We provide a small snack each day. Does your student have any food allergies or dietary restrictions?

Single Student Registration Fee (Member)

Price:

Additional Student (Member)

I would like to register an additional student

Additional Student Registration Fee (Member)

Price:

Additional Student Name

First Last

Age

Grade Level

3rd
4th
5th

T-Shirt Size

Each student will receive a camp t-shirt. Please select from the size options below.

Small
Medium
Large
X-Large

Are there any medical conditions of which we should be aware? Please describe.

We provide a small snack each day. Does your student have any food allergies or dietary restrictions?

Single Student Registration Fee (Non-Member)

Price:

Additional Student (Non-Member)

I would like to register an additional student

Additional Student Registration Fee (Non-Member)

Price:

Additional Student Name

First Last

Age

Grade Level

3rd
4th
5th

T-Shirt Size

Each student will receive a camp t-shirt. Please select from the size options below.

Small
Medium
Large
X-Large

Are there any medical conditions of which we should be aware? Please describe.

We provide a small snack each day. Does your student have any food allergies or dietary restrictions?

Emergency Contact

In the event of an emergency, every effort will be made to contact the parent/guardian of the student. If the parent/guardian is unreachable, we will contact the below listed person(s).

1. Contact Name*

First Last

Contact Phone*

Relationship to student:

2. Contact Name

First Last

Contact Phone

Relationship to student:

Liability Waiver

I understand that my student(s) will be participating in hand-on activities on and off the water as well as indoors and outdoors. I understand that every precaution will be taken to ensure the safety of my student while participating in these activities. In consideration of the risk of injury while participating in the STEAM Kids Summer Camp, I hereby knowingly and voluntarily enter into this waiver and release of liability and forever discharge the Michigan Maritime Museum, staff, and associated individuals and/or entities of any claim of liability in regards to personal injury that my student may suffer as a direct result of participating in the camp.

Consent*

I agree to the liability policy.

Date*

Minor (Child) Photo Release

I, the parent or legal guardian of the child and/or children listed on this registration form, grant The Michigan Maritime Museum my permission to use the photographs taken as part of the STEAM Summer Camp for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, and web content. Furthermore, I understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Photo Consent*

I agree
I do not agree

Date*

Registration Fee

Total Registration

$0.00

Payment Method*

Please select a payment option below.

I would like to mail a check (If you would like to mail a check (payable to Michigan Maritime Museum), send it to: STEAM Camp Registration, 260 Dyckman Ave. South Haven, MI 49090)
Credit card online (We will contact you with a link upon form submission)
Pay by phone (To pay by phone call 269-637-8078 ext. 103)

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