Spring Break STEAM Camp Registration

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Please fill out all fields. Upon registration acceptance you will receive an email confirmation. Camp size is limited to 20 students in each age category (5-8yrs and 9-13yrs). You will be asked to sign a copy of this registration upon arrival on the first day of camp.

Please indicate agreement with the following statements by checking the boxes. *

I understand the STEAM camp is a 3-day camp running W-F, March 27-29.

I understand that drop off is between 0730 and 0800 at Rally Point

I understand that pick up is between 1530 and 1600 at the playground

I understand that breakfast and lunch will be provided, but will provide my child's own snacks

I will provide a water bottle for my child

Required

Student First and Last Name: *

Please choose your child's age category. *

5-8 years old

9-13 years old

Current grade of student *

Kindergarten

1st grade

2nd grade

3rd grade

4th grade

5th grade

6th grade

7th grade

8th grade

Other:

Parent/Guardian Name: *

Parent/Guardian Email Address *

Service Branch of Parent/Guardian *

Air

Army

Contact Number (home/cell/work): *

Emergency Contact Name and Relationship to Student: *

Emergency Contact Number (home/cell/work): *

Health Information: Please list any health information that we should be aware of and any precautions that should be taken. Please list any food allergies as well. *

DoD STARBASE Idaho and Gowen Field Educational Outreach Agreement: I hereby grant permission for the aforementioned minor to participate in the DoD STARBASE Idaho program listed above. I understand that DoD STARBASE Idaho reserves the right to terminate participation in the program when it is deemed to be in the best interest of either the participant or the program. Should any property be damaged that is owned by the United States, I am aware that I may be asked to replace/repair that property if caused by my child’s actions/inactions. I also acknowledge that photographs and video may be used from time-to-time to document and promote DoD STARBASE Idaho activities and hereby consent to the use of photographs and video of the aforementioned minor for these purposes unless otherwise indicated below. Further, as consideration for my child’s participation in this program, I agree to release, hold harmless, and defend the United States Government, the Department Defense, the Idaho National Guard, the State of Idaho, and their respective officers, employees, agents, and volunteers, from and against any and all liability, claims, demands, actions, debts, liabilities and attorney’s fees arising out of or in any way related to the youth’s participation in the program. Moreover, I hereby authorize my child to receive emergency medical treatment whenever it is deemed reasonably necessary at any U.S. Military Facility or any other medical facility when a U.S. Military Medical Facility is not available. *

Agree

Please select one: *

I DO give STARBASE Idaho permission to use photographs or video for documentation and promotional purposes.

I DO NOT give STARBASE Idaho permission to use photographs or video for documentation and promotional purposes

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