2018 SeeBlue ChemCamp Registration
Please answer each of the following questions. The cost of the camp is $250 which includes everything (food, lab supplies, snacks, shirt, etc.)

The camp is from 9:00AM to 4:00 PM each day.

You will receive an invoice after we have confirmed your registration. This will allow you to pay via Credit Card, Debit Card or Check.

For more information please contact Dr. Margaret Mohr-Schroeder at seebluestemcamp@gmail.com or 859.285.0147.

Please allow 48 hours to receive confirmation of your registration and receipt of your invoice.

Student Last Name *
Your answer
Student First Name *
Your answer
Preferred Name on Name Tag
Your answer
Sex *
With what race/ethnicity do you identify? (check all that apply)
Are you eligible for free and reduced lunch?
We are required to collect this data to report impact of funding provided to the camp.
Is your student a possible first generation college student? (i.e., neither parent has earned a Bachelor's degree)
We are required to collect this data to report impact of funding provided to the camp.
Have you attended a See Blue STEM Camp before? *
Student Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Current Grade Level (2017 - 18 school year) *
Current School *
Your answer
T-Shirt Sizes *
Parking Pass Needed
If your student will be driving themself, we will have a limited number of parking passes available. Please note that UK is NOT liable for your student prior to their arrival into the meeting room each morning and after they leave the meeting room in the afternoon after Camp is over.
Guardian Name *
Your answer
Email to where the invoice should be sent *
Please note, the invoice will go to this email address! You can forward it on if necessary.
Your answer
Guardian Email 1 *
Camp information, updates, etc. will be sent to this email address.
Your answer
Guardian Email 2
Camp information, updates, etc. will be sent to this email address also. If you have more than 2 email addresses you want information to be sent to, please let us know - seebluestemcamp@gmail.com and we'll add them to the list!
Your answer
Guardian Phone Number *
Please leave the number you prefer us to contact you at.
Your answer
Food Allergies
Every effort is made to provide snacks and lunches that will meet your student's dietary needs. We will send out food information 2 weeks prior to camp.
Your answer
Relevant Medical Information
We have staff that are trained in epipens, but please let us know in advance if your student will be bringing one.
Your answer
Relevant Educational Information
All of our staff are inservice teachers, preservice teachers, and graduate students with an education background. If your student has a IEP or 504 or other special educational needs, please let us know here so we can meet the needs of your student to ensure a positive camp experience!
Your answer
Other Special Notes to the Staff
Your answer
By typing my name below, I, the guardian of this student, give them permission to attend the 2018 SeeBlue ChemCamp. *
Please type your full name. This serves as your signature.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service