HYPOTHESIZE
EXPERIMENT
DISCUSS
SUMMER LITTLE SCIENTISTS CAMP
Keep inquisitive minds learning this summer with Little Scientists Camp. We will form a hypothesis,
experiment, and discuss our findings each day while learning about chemistry, geology, gooey fun, and
more!
Registration begins May 16
AGES
6-12 Years Old
WHEN
July 11-July 15
Monday—Friday
1-4pm
FEE
$40 Member; $25 Second Member
$50 Program Member
CONTACT
Youth & Family Director, Julie Farmer
[email protected]
360 336 9622
Like Us!
SKAGIT VALLEY FAMILY YMCA
215 East Fulton Street, Mount Vernon WA 98273
P 360 336 9622 F 360 336 9624 | www.skagitymca.org
Www.sk
LITTLE SCIENTISTS
Summer 2016
GENERAL INFORMATION ABOUT THE CAMP:



For kids ages 6-12.
Little Scientists will be from 1-4pm July 11-July 15 at the YMCA, prior registration is required.
Kids will spend the day learning how fun science can be!
Registration: Registration for all camps begins May 16, 2016. Must register by the Friday before the session begins.
Camp Dates: July 11-July15
Fees:
$40 Full-Facility Member; $25 Second Full-Facility Member; $50 Program Member
Little Scientists Registration
Name
______________________
Parent/Guardian
______________________________
Address
_____________________
Home Phone
_____
Birthday ___
Age
__ Gender __ __
__ Email_________________________________________________________________________
__
________City__
______
Alternate Phone ___________
Emergency Contact
____________
Special Considerations (i.e. health conditions, etc)
__
___
_____
_____Zip______
_______________
Phone
____________
Participation and Release of Liability
Release/Participation: I am the parent or guardian of the participant. I give my permission for my child to participate in YMCA activities. I understand that accidents can sometimes happen.
Therefore, in exchange for the YMCA allowing my child to participate in YMCA activities, I understand and expressly acknowledge that I release the YMCA, its employees, boards, members,
volunteers or guests from all liability for any injury, loss or damage connected in any way whatsoever to participation in YMCA activities whether on or off the YMCA’s premises. I
understand that this release includes any claims based on negligence, action or inaction of the YMCA, its employees, boards, members, volunteers, or guests.
Medical Treatment: I give permission for YMCA staff or volunteers to provide emergency medical treatment for my child, and to transport to an emergency center for treatment. Also, I
consent to medical treatment for my child deemed immediately necessary or advisable by a physician.
Insurance: I understand that the YMCA does not provide any accident or health insurance for its members or participants and further understand it is my responsibility to provide such
coverage.
Member Conduct: I agree for myself and my child to abide by the YMCA code of conduct and all policies and procedures of the Skagit Valley Family YMCA. YMCA participation excludes
Level 2 and Level 3 Registered Sex Offenders.
Property Loss: The YMCA is not responsible for personal property lost, damaged, or stolen while using YMCA facilities, including parking lots, or participating in
YMCA programs.
Photograph Permission: I give permission for the YMCA to use, without limitation or obligation, photographs, film footage or tape recordings which may include my child’s image or voice
for purposes of promoting or interpreting YMCA programs .
Parent/Guardian (print)
_____________
Signature
Date
Office Use Only
Code 11-1318
Amt pd:
Type PYM:
Date:
Initial:
Like Us!