Summer STEM Camp Detailed Registration Form

STEM Heads

Summer STEM Camp Pre-Registration
Cost:

$120 for six weeks (covers $10/week for Camp, and $10/week for Field Trips)
STEM ABCs (Ai, Biotech, and Chemistry)

Session 1: June 9th - 20th Join in activities to explore, create, and problem solve within the intersection of Artificial Intelligence (Ai), Biotechnology, and Chemistry. Combine computer science, mathematics, engineering, and chemistry to explore a new world during this session.
Fireworks & Energy Flow (Chemical Reactions & Physics)

Session 2: June 23rd - July 3rd Learn about Pyrotechnic Engineering in this session. Design and formulate your own fireworks just in time for the FORTH OF JULY! This energy-packed STEAM session combines art, virtual reality, chemistry and physics in a hands-on experience as students demonstrate chemical reactions and learn about how reactions produce different colors.
Kitchen Chemistry (Chemical Reactions & Physics)

Session 3: June 29th - July 10th Navigate the kitchen lab using popular bench research techniques. Experientially investigate atomic and molecular properties in this kitchen chemistry experience, which combines art, chemistry, and physics theory.
Toxicology & Me (Environmental Science, Chemical Reactions, Math, & Technology)

Special Session 4: July 13th - 24th During two additional weeks of STEM Camp, campers learn and journal about plants and insects in nature. LSU School of Public Health joins camp to guide students through exploring air quality in our community; and campers explore water quality through sample collection, taking measurements, and analyzing sample data out at the park. Youth consider the intersection of science and society in this session, which provides a sense of responsibility for our earth. This two-week session costs an additional $40.
Camp Fees: $120

There is a $60 Field Trip fee that covers weekly Summer STEM Field Trips for all three sessions. The fee is non-refundable. There is also a $60 STEM fee that covers all program activities and materials for students during six weeks of camp. Following the six week camp, there is an additional two week Special Session. Please submit payment for the special session separately online at
Camper's Information
Name

First NameLast Name
E-mail
example@example.com
Session(s) of Interest

Session Number & DatesHow many additional siblings attending? (Type "0" if none.) Please register all applicants separately.
Birth Date

MonthDayYear
School
Grade
MaleFemaleOther
Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeOther
Parent/Guardian Information
Name

First NameLast Name
E-mail
example@example.com
Cell Number
Format: (000) 000-0000.
Home Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information
Emergency Contact's Name

First NameLast Name
Relationship to Camper
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Second Emergency Contact's Name

First NameLast Name
Relationship to Camper
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the camper prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by STEM Heads Organization during the Summer STEAM camp. In exchange for the acceptance of my child’s candidacy by STEM Heads, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless STEM Heads. and all its respective officers, agents, and representatives from any and all liability for injuries to my child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to my child, I hereby waive all claims against STEM Heads, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization

As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the STEM Heads, and its affiliates including Directors, Educators, Volunteers, and other staff to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

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Camp and Field Trip Registration
The $60 Field Trip fee payment confirms your camper's pre-registration in the Summer STEM Field Trip for all three sessions. The fee is non-refundable. The $60 Registration fee covers all program activities and materials for students during six weeks of camp.

$120.00



Before Care
After care is available at a rate of $5/day or $25 for the week.

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After Care
After care is available at a drop-in rate of $5/day or $25/week. Please select how many days needed from the drop down menu.

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STEM Heads

Cost:

STEM ABCs (Ai, Biotech, and Chemistry)

Fireworks & Energy Flow (Chemical Reactions & Physics)

Kitchen Chemistry (Chemical Reactions & Physics)

Toxicology & Me (Environmental Science, Chemical Reactions, Math, & Technology)

Camp Fees: $120