Astro Camp - Registration Application Astro Camp ® will be held at Infinity Science Center, located at 1 Discovery Cir, Pearlington, MS 39572. (Payments and registration forms should not be mailed to this address see address below.) Total tuition cost for Astro Camp is $140 per camper. Astro Camp/Stars tuition, in part, covers the cost of the materials used in the course of the camp, including daily meals and snacks, t-shirts, camp journals and consumables for hands-on activities. Please make check or money order payable to NVision Solutions, Inc. The registration application, check and all related forms should be mailed to: NASA Stennis Space Center Office of Education Attn: Nvision Solutions, Inc./ASTRO CAMP Roy S. Estess Bldg. Room 108 Stennis Space Center, MS 39529-6000 Registration forms may only be mailed; they may not be hand delivered. If you have questions, please call the NASA Education Office Astro Camp Line at 228-688-3485, or 1-800-237-1821 (Option 4). First Day of Camp Processing - MONDAY - 8:00 a.m. All parents and campers must report to the Astro Camp Infinity Science Center for day-one drop off, followed by parent orientation held at 8:35 a.m. Camp hours are 8:00 – 3:30 daily. Please circle only one session of camp (offered by grade/date). Grade level refers to grade the child will be entering in the fall: Astro Camp 2 nd – 4 th Graders Astro Camp 5 th – 7 th Graders STARS 8 th – 10 th Graders June 5-9, 2017 June 5-9, 2017 June 12-16, 2017 June 12-16, 2017 June 19-23, 2017 June 19-23, 2017 June 26-30, 2017 June 26-30, 2017 July 10-14, 2017 July 10-14, 2017 July 17-21, 2017 July 17-21, 2017 Camper’s Name: _________________________________________________________ Age: ________ Mailing Address: _______________ ____________ City/State/Zip: Parent’s/Guardian’s Name Daytime Phone: ( ______) ____Evening Phone: (_______) __________________ Email: ____________________________________________ Please circle T-shirt size: Youth M Youth L Adult SM Adult M Adult L Adult XL NOSL- Astro Camp Summer 2017 1
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Astro Camp - Registration Application · Astro Camp - Registration Application. Astro Camp ® will be held at Infinity Science Center, located at 1 Discovery Cir, Pearlington, MS
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Astro Camp - Registration Application
Astro Camp® will be held at Infinity Science Center, located at 1 Discovery Cir, Pearlington, MS 39572. (Payments and registration forms should not be mailed to this address see address below.)
Total tuition cost for Astro Camp is $140 per camper. Astro Camp/Stars tuition, in part, covers the cost of the materials used in the course of the camp, including daily meals and snacks, t-shirts, camp journals and consumables for hands-on activities.
Please make check or money order payable to NVision Solutions, Inc.
The registration application, check and all related forms should be mailed to:
NASA Stennis Space Center
Office of Education Attn: Nvision Solutions, Inc./ASTRO CAMP Roy S. Estess Bldg. Room 108 Stennis Space Center, MS 39529-6000
Registration forms may only be mailed; they may not be hand delivered.
If you have questions, please call the NASA Education Office Astro Camp Line at 228-688-3485, or 1-800-237-1821 (Option 4).
First Day of Camp Processing - MONDAY - 8:00 a.m. All parents and campers must report to the Astro Camp Infinity Science Center for day-one drop off, followed by parent orientation held at 8:35 a.m. Camp hours are 8:00 – 3:30 daily.
Please circle only one session of camp (offered by grade/date). Grade level refers to grade the child will be entering in the fall:
Email (optional) please print - _______________________________________________________________ Email will be used to send notification of upcoming camps and communication during camps. ASTRO CAMP BEHAVIOR POLICY The Astro Camp staff strives to ensure that every camper has a safe, fun and meaningful experience. Instances of unsafe behavior or misconduct, or failure to follow the directions of the staff, detract from this experience. Flagrant or repeated misbehavior will result in removal of a camper from the camp session. Upon removal from camp, readmission will be evaluated on a case by case basis, and only after a parent/staff conference. PARENTAL AUTHORIZATION
News Release As a camp participant, your child may have their photo and/or name included in our news releases or NASA website. By registering your child and completing this form, you acknowledge and authorize this action.
Camper Release To assure the protection of Astro Camp participants, please provide the name and relationship of the individuals who have your permission to pick up your child. Your child will not be released without this permission. The camp supervisor/coordinator must be notified as soon as possible for early release. Forms will be provided during camp for parents’ to place additional persons on the approved permission list for child pickup. By signing this, you acknowledge that your child will not be considered as delivered into the safekeeping of Astro Camp personnel, unless the child is delivered directly to personnel at the check in table on the second floor of Infinity.
Transportation to Events Children will be transported to events at Stennis Space Center or Michoud on NASA/Infinity tour busses. If a child becomes ill, it may be necessary for personnel to transport the child to the clinic on Stennis Space Center along with any medical information provided about the child. If a child is transported to the clinic, the parent/guardian will be notified as soon as possible. By signing this form you acknowledge and authorize that under these circumstances, your child will be transported away from Infinity Science Center. ________________________________ __________________________________ Name Relationship to Child ________________________________ __________________________________ Name Relationship to Child I hereby acknowledge and authorize all of the statements above. SIGNATURE OF: ____________________________________________________ Date: ____________ PARENT / GUARDIAN
NOSL- Astro Camp Summer 2017 2
RELEASE/CONSENT FORM Stennis Space Center
Please print name:___________________________
[Please read the following consent statement and sign below.]
I hereby consent, release and provide permission to NASA’s Stennis Space Center to use (in full or in part) all photographic and videotape images taken of me and/or audio recordings made of my voice without consideration or compensation. The images/recordings captured may be used in brochures, news releases and other types of venues and materials to promote NASA’s programs.
I hereby consent:___________________________ ________________ PLEASE SIGN YOUR NAME HERE
Parent’s Name (same listed on registration):_____________________________________________________
Medical Release In the event of a medical emergency, I hereby authorize Astro Camp medical personnel designee to treat my child, who may be transported to the nearest medical facility, including a Medical Clinic. I also hereby confirm that I have read and will comply with the “Camper Health and Medication Policy.”
Please complete the Medication Authorization Form if medication is required.
Relationship to child: _______________________________________________________________
Health Information In order to ensure your child's educational needs are met, please provide us with any information that would help us accommodate your child. (For instance, Astro Camp involves group and individual activities that may result in loud unexpected noise that could over stimulate some children.)
Use the space below to provide any information regarding chronic illness, allergies, or any other health or behavior information that may be helpful in assessing or treating your child in case of illness or emergency. Please be as thorough as possible; attach a separate sheet if necessary.