Home School Days Registration 2017
Friday, January 13: Healthy New Year
It's a new year, become a new you! Activities may include exploring the five food groups and how to maintain a healthy diet. Learn how astronauts train and remain healthy. Investigate how your body reacts to some of your favorite foods.

Friday, February 10: Full STEAM Ahead
Add art and creativity to the growing world of technology! Activities may include exploring the world of 3D printing, implementing 21st Century skills, and integrating creativity to build inventions that solve everyday problems.

Friday, March 10: Dream Machines
Unleash your dreams and become an energy engineer for a day! Activities may include using LEGOs and snap circuits to explore different forms of energy. Build solar cars and model boats to complete various challenges. Camp includes $1.00 discount to the brand new IMAX film Dream BIG 3D.

Friday, April 14: All Things Small
It's a small world after all! Experiments may include using microscopes, magnifying lenses, and learning about small cells of living things. Investigate microparticles and the use of nanotechnology.

Friday, May 12: Into the Amazon
Learn about one of the most diverse places on Earth and the creatures that call it home! Explore how animals adapt to survive in different environments. Investigate how animals compete and interact with each other. Camp includes a $1.00 discount to the brand new IMAX film Amazon Adventure 3D.

Program Information
Cost
Programs are $20 per student per program, due at registration. Family membership holders receive a 10% discount. Fee includes all materials and a popcorn snack.

Program Information
Program sessions are held on the second Friday of each month from 9:00 am - 12:00 pm. If you have a Home School Group of at least 16, additional dates and times may be available. Contact the Group Sales Coordinator for more information.

Parents are permitted, but not required to attend with child.

Registration
Registration forms must be completed and submitted no later than 48 hours before the session date. Registration is complete on receipt of full payment.

Cancellations/Refunds
Requests for cancellation must be received in writing by the CLC prior to the program session date. Full refunds will be allowed for written requests received 48 hours before the session date. No refunds will be granted less than 48 hours before the session date. Please allow approximately 90 days for refunds to be processed, unless payment was received by credit card.

Contact Information
Should you need additional information, please call (850) 645-7777 weekdays from 7:00 am to 4:00 pm. For content/curriculum questions, contact our Education Manager at (850) 645-7787.

Parent/Guardian Name
Your answer
CLC Family Membership Holder?
Address
Your answer
City, State Zip
Your answer
Email Address
Your answer
Phone
Your answer
Home School Group Affiliation (If Applicable)
Your answer
Student Information
Student 1
Name
Your answer
Grade
Your answer
Age
Your answer
Birthdate
MM
/
DD
/
YYYY
Student 2 (If applicable)
Name
Your answer
Grade
Your answer
Age
Your answer
Birthdate
MM
/
DD
/
YYYY
Student 3 (If applicable)
Name
Your answer
Grade
Your answer
Age
Your answer
Birthdate
MM
/
DD
/
YYYY
Student 4 (If applicable)
Name
Your answer
Grade
Your answer
Age
Your answer
Birthdate
MM
/
DD
/
YYYY
Program Selection
Please choose one or more.
Program Dates
Required
Payment Information
Registration is complete on receipt of full payment. Registrations accepted on a first-come, first-serve basis.

VISA, MasterCard, American Express, Discover, check or cash only. Our fax line is secured and can transmit credit card information safely. Please do not mail cash. Cash may be dropped off at our administrative offices during business hours. If paying by check, you must also provide your driver's license number.

Total Amount to be Charged:
$20 per session per student (minus 10% discount if CLC Family Membership Holder)
Your answer
Payment Type
*If you select credit card, the Group Sales Coordinator will call to collect your payment information via phone. You may also contact the Group Sales Coordinator at (850) 645-7777 if you prefer. If you select the check option, please bring/mail in a check after you submit this form. If you select the cash option, please bring the cash to the Challenger Learning Center after submitting this form.
Required
If paying by check, please remit to:
Camp Challenger!
Challenger Learning Center of Tallahassee
200 South Duval Street
Tallahassee, FL 32301
Electronic Signature
Please print name.
Your answer
Medical History & Consent Form
Student Name(s)
Please list all siblings attending (if applicable)
Your answer
If reasonable attempts to contact me at the above numbers have been unsuccessful, I hereby give my consent for the administration of any treatment deemed necessary by: (see below) or in the event preferred practitioner is not available, by another licensed physician or dentist.
"Dr. _________, preferred physician at __________ (telephone #) or Dr. _________, preferred dentist at _________ (telephone #)"
Your answer
I desire my child to be transferred to: _______________ (preferred hospital or any hospital reasonably accessible). This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists have concurred in the necessity for surgery.
Your answer
Please list any facts concerning each child's medical history, any physical impairments or conditions, and medications currently taken to which a physician and the CLC should be informed.
Send in any additional documentation to our mailing address or fax number.
Your answer
Electronic Signature
Please print name.
Your answer
Media Release
This is to certify that I, _____________, give permission to the Challenger Learning Center, Florida A&M University and Florida State University to photograph and/or videotape for use on their website, promotional brochures or during a local newscast or print interview. I understand that all rights, title and interest in the photography used belong to the Challenger Learning Center, Florida A&M University and Florida State University and that I will receive no financial compensation for the use of these pictures and/or videotape. I further understand that the above agencies may edit, copy, alter, or revise the photographs and/or videotape for use on our website, promotional brochures or during a local newscast or print interview and that the above agencies will retain control over the use and distribution of the photographs and/or videotape. I have read this form and I understand its meaning.
Electronic Signature
Please print name.
Your answer
Liability Release
I, ____________, hereby grant my child(children), _____________, permission to attend the Challenger Learning Center's Home School Days program, and release CLC staff, Florida A&M University, Florida State University, instructors, employees, sponsors and the Challenger Learning Center of any and all liability connected with his/her/their attendance.
Electronic Signature
Please print name.
Your answer
Policy Acknowledgement
I have read and understand the program information and policies, including the policy on cancellations.
Electronic Signature
Please print name.
Your answer
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