Roberson Member Summer Camp 2023 Registration

Roberson Member - Summer Camp 2023 Registration

June - August 2023
We are pleased that your child will be joining us this year for camp! The following information will ensure your child has the best possible experience.

Lunch: Children will need to bring a lunch with them, as lunch will not be provided. Please write your child’s name on his/her lunch box or bagged lunch. We do offer drinks for sale in our Gift Shop for those interested. If your child’s lunch needs to be refrigerated please let us know each morning.

Attire: We like to make a mess in our programs, so your child should wear clothes that can get a little paint and dirt on them. Please ensure that your child arrives at Roberson wearing comfortable footwear. Children in all programs may spend some time outside in our courtyard or near our picnic tables, depending on weather.

Forms: On the following page you will be prompted to complete Emergency Contact and Medical Information forms. Your child will not be able to participate in programs without these forms completed. For the safety of your child and our other campers please make sure these forms are completed as accurately as possible.

Drop-off and Pick-up: We require an authorized signature and photo identification at the beginning and end of the program. Please inform the Museum Educator, and indicate on the following form, of any variation in pick-up time or if someone else is picking up your child. Drop-off for programs is from 8:45 – 9:00AM. Pick-up is at 3:00PM (unless you have previously arranged for our extended care service which is an additional $6 for the day from 8:00-9:00AM and 3:00-5:15PM).

Emergency Contact for the Museum: If for any reason you need to contact the museum (i.e. picking up your child early) please call the museum’s front desk (607) 772-0660, and they will get you in contact with the appropriate person.

If you have any questions or concerns please contact me at (607) 772-0660 ext. 262 or jnaczi@roberson.org.
Thank you.

Jordi Naczi, Education Coordinator
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Please enter your Roberson Member ID*

I. Parent/Guardian Data
Primary Parent/ Guardian*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Parent/ Guardian

First NameLast Name
Phone Number

Area CodePhone Number
II. Other Emergency Contacts
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to child*
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child
III. Pick-up Information

Please list any additional persons who will be picking up your child. Photo ID will be required at drop off and pick up.
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child

IV. Medical History

If there are any medical conditions, allergies (food, bee stings, etc.) or medication needs for your child, please list them below. Roberson Staff will not administer medications. This information will not exclude your child from participation.
Does your child have any of the following?

Insect sting allergiesDiabetesFood/Medication AllergiesAsthmaSeizure Disorder
If you checked YES to any of the above, please specify, including severity of any possible reaction.
Will your camper require medications (including EpiPens and Inhalers) while at camp? (Specify what kind)
Any other health concerns we should know about?
Special Needs: We strive to provide an accessible and safe environment for all campers. If your camper has special needs, please provide details on how we can assist your camper in having the best experience with us possible.

V. Photo Release
I hereby give permission for Roberson Museum and Science Center to use photographs, video or digital images of my child for publicity, promotion and documentation of this program, and to reprint my child’s written material.*

I agreeI do not wish Roberson to use photographs, video or digital images of my child.

By registering this camper, you give permission for your camper to participate in Roberson Museum and Science Center’s Spring Break Camp and agree to the following items:

I agree to assume all risks and liabilities associated with my child’s participation in said programs and to hold Roberson Museum and Science Center harmless from all claims which may arise as a result of participation.

Please read Camp Information and Policies 2023

By signing the below, I agree that I have received, read, and understood the information provided in Camp Information and Policies (linked above) which is also listed on Roberson Museum and Science Center’s Website.
Signature*

Clear

Payment
Camp Options*
prevnext( X )
Abrakadoodle Art (2-4)$200.00
MONDAY, JUNE 26 – FRIDAY, JUNE 30

Creature Features (Grades 2 – 4)$200.00
MONDAY, JULY 3 – FRIDAY, JULY 7 (NO camp July 4th)

Fun with Food (Grades 5 – 7)$200.00
TUESDAY, JULY 3 – FRIDAY, JULY 7 (NO camp July 4th)

Sensational Senses (Grades 2 – 4)$200.00
MONDAY, JULY 10 – FRIDAY, JULY 14

Pirate Adventure (Grades 2 – 4)$200.00
MONDAY, JULY 17 – FRIDAY, JULY 21

Go Green Boot Camp (Grades 5 – 7)$200.00
MONDAY, JULY 17 – FRIDAY, JULY 21

Recycled Art (Grade 5 – 7)$200.00
MONDAY, JULY 31 – FRIDAY, AUGUST 4

Mythological Creatures (Grades 2 – 4)$200.00
MONDAY, AUGUST 7 – FRIDAY, AUGUST 11

Before and after camp care$100.00
Please select how many weeks of before and after camp care you would like

How many weeks

Total $0.00
loading smart payment buttons...

The payment is ready! It will be completed once you submit the form.
Should be Empty:

Roberson Member - Summer Camp 2023 Registration

I. Parent/Guardian Data

II. Other Emergency Contacts

III. Pick-up Information

IV. Medical History

V. Photo Release

Payment