Hands On! Museum
Summer Camp 2016
Registration Packet
Where else can you custom tie dye a t-shirt, blast off Mentos geysers, create your own custom-fitted and hula
hoop, send suds flying into the air, make ooey gooey silly putty, paint a masterpiece, build an air rocket, and
much, much more?!?! Children ages 5 to 12 can explore and discover the sciences, arts, and more in our week
long summer camps that are sure to make fun, silly, and educational memories sure to last a lifetime.
Please call (423) 434-4263 ext. 100 or email [email protected] for more information or to
register. You may send in the registration form via email or postal mail, or deliver in person.
Choose the week of camp that is right for your camper:
 Monday, June 13th-Friday, June 17th
 Monday, July 18th-Friday, July 22nd
Choose the type of day that is right for your camper:
 HALF day (Drop off 9:30-9:45, pickup 12:15-12:30)
o Cost: $ 100 for members, $150 for non-members
o Includes a Hands On! t-shirt for tie dyeing, all activity and experiment supplies, play time in the
museum, drinks provided at mid-morning snack time. Half day campers need to bring a NUT FREE
snack and extra clothes and shoes daily.
 FULL day (Drop off 9:30-9:45, pickup 4:15-4:30)
o Cost: $ 150 for members, $200 for non-members
o In addition to what half day camps include, full day camps include additional activities and
experiments, extended play time in the museum, drinks provided at snack and lunch times. Full
day campers need to bring 2 NUT FREE snacks, a NUT FREE lunch, and extra clothes and shoes daily.
Choose your session/length of day and pricing tier:
____ June 13th-17th, HALF day
____ Hands On! Member $100
____ June 13th-17th, FULL day
____ Hands On! Member $150
th
nd
____ July 18 -22 , HALF day
____ Hands On! Member $100
____ July 18th-22nd, FULL day
____ Hands On! Member $150
____ Non-Member $150
____ Non-Member $200
____ Non-Member $150
____ Non-Member $200
Child’s name:
First __________________ Middle _______________ Last ____________________ Nickname: ________________
Date of birth (DD/MM/YY) __________
Gender: ____ M
____ F
_____ Decline to answer
____ Youth Small
____ Youth Medium
(You may be asked to provide proof of age)
Child’s t-shirt size: ____ Youth X-Small
____Youth Large
Please list any allergies and/or sensitivities (we are unable to administer any medications):
_______________________________________________________________________________________________
Please list any restrictions to activity (physical limitations, what adaptations are required):
_______________________________________________________________________________________________
Please list any behavioral, medical, physical, emotional, mental health, or special needs ***:
_______________________________________________________________________________________________
We would like to get to know a little more about your child. Please list any hobbies, interests, skills.
_______________________________________________________________________________________________
Parent/Guardian Name ___________________________________ Relationship to child _____________________
Address _________________________________________________ City/State/Zip __________________________
Phone number _________________________ Alternate phone number ___________________________________
Email ___________________________________________________
Secondary/Emergency Contact ________________________________ Relationship to child __________________
Phone number _________________________ Alternate phone number ___________________________________
No pick-up list
We are aware that you may not want your child to be picked up by certain individuals. If so, please list those
individuals below, and let us know of any additional questions or concerns.
Name _____________________________________________ Relationship to child _______________________
Name _____________________________________________ Relationship to child _______________________
Please read carefully:
I have read and understand the following:
 A separate registration form must be completed for each child.
 Campers must be 5 years old by June 1, 2016 and no older than 12 years old on June 30, 2016. Proof of age may
be asked to be provided prior to as well as during camp. If the museum has been purposefully misinformed as
to the age of the child, all fees paid will be forfeited and the camper dismissed.
 All campers must be fully potty trained.
 A 50% deposit is due at registration. Full payment is due a minimum of 2 weeks prior to the start date of camp.
 You will receive a full refund if you cancel at least 2 weeks prior to the start of camp. If a cancellation is made
less than 2 weeks in advance, your deposit will not be refunded.
 Hands On! Museum reserves the right to cancel any camp and will fully refund payments in the event that a
camp is cancelled based on attendance/registration or unforeseen circumstances.
 All campers should pack a NUT FREE snack (1 for half day, 2 for full day) daily. Choice of juice or water will be
provided with snack.
 Full day campers should also pack a NUT FREE lunch daily. Choice of juice or water will be provided with lunch.
 Ensure your camper has an extra set of clothes and shoes with them daily. We make a lot of fun messes!
 Parents/guardians must sign each child in and out of camp each day. We are unable to accommodate drop offs.
 Please sign your child in and sign out in accordance with scheduled camp times. We are unable to
accommodate early arrivals or late pick-ups. In the event of an emergency, please contact the front desk as
soon as possible.
 To ensure a fun, effective, and consistent camp experience, we ask that parents/guardians/siblings are not
present during camp hours.
 Hands On! Museum is not responsible for lost or stolen items.
Sign: ________________________________________ Date (MM/DD/YY): _________________________
I authorize Hands On! Regional Museum to capture, use, publish, and reproduce photographs, slides, moving
pictures, or video for its records, public relations programs, social media, and promotional purposes. Permission is
granted for the camper to participate in all planned camp activities and programs, except as otherwise noted.
Sign: ________________________________________ Date (MM/DD/YY): _________________________
I understand that a 50% deposit is due at the time of registration to reserve a spot for my child. I understand that
full payment is due no less than 2 weeks prior to the start of camp. No refunds will be given for camp registrants if
canceled less than 2 weeks in advance. I also understand that no refunds or transfer of funds will be made for
withdrawal, failure to attend, or incomplete attendance.
Sign: ________________________________________ Date (MM/DD/YY): _________________________
***I understand that Hands On! Regional Museum is not equipped for and does not charge in its normal session fees
for providing any special needs services. Parents of children with special needs must provide the nature and scope of
these needs for review by the staff. Hands On! Regional Museum reserves the right to determine a camper’s special
needs beyond the scope of the program capability or requiring a special qualified staff person, responsible for
his/her needs.
Parents/guardians are required to provide and pay for an assistant for the child in addition to the standard session
fee. If full disclosure does not occur and special needs become apparent to the camp’s staff, all fees paid will be
forfeited and the camper dismissed.
Sign: ________________________________________ Date (MM/DD/YY): _________________________
I hereby waive Hands On! Regional Museum its officers, employees, and volunteers from any liability of injury, loss,
or damage to personal property associated with this event.
Sign: ________________________________________ Date (MM/DD/YY): _________________________
Print parent/guardian full name: _________________________________________________
Print child’s full name: __________________________________________________________