STEM Science CV Summer Day Camp Registration Form 2025

STEM Science CV 2025 Camp Registration
Registration is now open for Explorer Children's School STEM Science Summer Day Camp! Please complete this form for each of your campers.

www.explorerchildrensschool.com
Camp Info

Day camp will be held at the Mallard Picnic Site at Lake Chabot in Castro Valley, 9 am to 3 pm Monday - Friday. Park and walk the short distance to the site.

This year's theme is "Science through Art", learning science concepts through different fun art mediums, taking home a couple creations a day! Teacher Sandra is excited to serve as camp Director, and has written and planned all curriculum; camp will be taught by experienced science teachers and staff under Sandra's supervision.

The cost of attendance is $445 + $35 in materials, totaling $480 per week. (sibling OR CVPNS discount $25) No refunds after Feb 21st. Teacher-to-student ratio is 1:5-6. Open to campers ages 4 to 12 yrs.

Your camper is welcome to attend either or both weeks! Repetition is common & highly encouraged. We can't wait to see your little science artists in action! Email me with any questions at sandrat@explorerchildrensschool.com.
Which week(s) would your camper like to attend?*

WEEK 1 IS FULL, email for waitlist: June 9th - 13th, 2025WEEK 2 IS FULL, email for waitlist: June 23rd - 27th, 2025

CONTACT INFORMATION
Camper Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
School & grade in Fall 2025*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian #1 Name*

First NameLast Name
Parent / Guardian #2 Name

First NameLast Name
Parent / Guardian #3 Name

First NameLast Name
Email(s)*
example@example.com
example@example.com
Primary Phone Number*
Please list all phone numbers where the parent/guardian(s) can be reached and their type (i.e. home, mobile, office).
ex. Jamie's Cell: (555) 123-0000, Alex's Office: (555) 123-9999
Please list all those allowed to drop off & pick up your child, other than the parent/guardians listed above (if any), their relationship to your child, and their phone number.
ex. Katherine Johnson, Maya's Grandmother: (555) 123-4444
Emergency Contact #1*
Emergency Contact #2*

MEDICAL INFORMATION
Primary Care Physician*

First NameLast Name
Physician's Phone Number*
Please enter a valid phone number.
Medical Insurance Company*
Insurance Phone Number*
Please enter a valid phone number.
Policy/Group ID#*
Policy Holder's Name*

First NameLast Name
Please answer the following in full detail. If not applicable to your camper, or write "none".
List all medications the child will take during the hours of camp. For each, include the a) Medication Name, b) Dosage, and c) Dispensing Instructions.*
This includes any prescription, non-prescription medications, herbal supplements and vitamins; to only be carried and dispensed by STEM Summer Camp adult staff.
List any medical conditions your child has:*
ex. asthma, diabetes, epilepsy, etc.
List any allergies (drug/medicine, food, and/or environmental) and the severity and type of reaction:*
Please explain any other pertinent information about the participant (i.e. physical, behavioral, or emotional) that would be important for the adult leaders to know.*

CONSENT & RELEASE FORMS
PARENTAL CONSENT

I, First Name* Last Name* , the undersigned do hereby give permission for my child, {camperName} (“Participant”), to attend and participate in STEM Science Summer Day Camp during the period of June 9, 2025 – June 27, 2025.

Signature* Date*
LIABILITY RELEASE

In consideration of STEM Science Summer Day Camp, I, the undersigned, do hereby release, forever discharge and agree to hold harmless STEM Science Summer Day Camp, Sandra Turretta, its teachers and assistants from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the children/youth activities and childcare. I, the parent or legal guardian of this Participant, hereby grant my permission for the Participant to participate fully in STEM Science summer day camp activities. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation activities involved therein.

Signature* Date*
MEDICAL TREATMENT PERMISSION

I authorize a STEM Science Summer Day Camp adult, in whose care the minor has been entrusted, to carry out any required medical care for my child, knowing they are up to date in their CPR/first aid professional training. I also authorize medical care from first responders, staff of a licensed hospital or emergency care facility, should the need arise. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such medical services rendered to the aforementioned child or youth pursuant to this authorization.

Signature* Date*
PHOTO RELEASE FORM

I DO / DO NOT agree that STEM Science Summer Day Camp may photograph and record my child/dependent’s likeness and activities during summer 2025 camps. I grant STEM Science permission to use or publish images for editorial, commercial, trade show, or advertising.

Child's Name: {camperName}
Parent/Guardian Name: {parent}
Address: {homeAddress}
Phone Number: {primaryPhone}
Email: {emails}{email}

Signature* Date* DO agree DO NOT agreee* p>

PAYMENT
Full payment is due at the time of registration.

The cost of attendance is $445 + $35 in materials, totaling of $480 per week. Discounts of $25 per week are offered for concurrently registered siblings OR CVPNS families/alumni.

Payment can be made via...
- Zelle sent to (415) 577-7101
- Venmo @Sandra-Turretta is acceptable as a 'goods/service' only if you include their additional fee of 2.99% or $14.85 -- total of $494.85 (email me if you have questions)
- Check made out to Sandra Turretta, (email sandrat@explorerchildrensschool.com for mailing instructions)
Your spot in the day camp will be confirmed once payment is recieved and a confirmation email is sent to you.

Registrations recieved without prompt payment may be waitlisted. Don't delay!
Number of weeks attending:*

One WeekBoth Weeks
Is this camper a sibling of another registered camper attending this summer?*

YesNo
CVPNS student or alumni?*

YesNo
My total due now is:*
$480 per week - subtract EITHER $25 for CVPNS alumni OR $25 for siblings
I am sending payment via...*

CheckZelleVenmo
Is there anything else about your camper we should know?
Please verify that you are not a robot*
Should be Empty:

STEM Science CV 2025 Camp Registration