• Please fill out one form per student. This camp is FULL except for the MADISON cohort. Please only register if you have a code from Madison Schools.

    RoboTech - Co-Ed Week | June 16th-20th, 2025

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      SMI Camp - RoboTech (Co-Ed Week)
      $200.00$200.00
        
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    • 2025 RoboTech Paperwork & Emergency Medical Form

      Please fill out this questionnaire as completely as you can. We believe that electronic records will be easier for our staff to access in the event of an emergency. Thank you for your cooperation!

    • Camper & Parent Information

    • Format: (000) 000-0000.
    • Format: (000) 000-0000.

    • CAMPER PICKUP

    • The following individuals, besides the parents listed above, are permitted to pick up my child: (provide name, relationship to child, phone number).

    • Field Trip / Facility Use Agreement

    • Talent Release

    • I hereby consent and authorize the Summer Manufacturing Institute (SMI) to publish photographs and video recordings, taken by the SMI during camp hours or during camp sponsored events, of my student on their website, social media, brochures or other print-based promotional materials. I hereby and forever release and discharge the SMI, camp employees and its partner organizations from any and all claims arising out of or in connection with the use of photography and/or video recordings in which my child’s image appears, on its website and in brochures or other promotional materials, including, without limitation, any and all demands, causes, actions, suits, costs, expenses, liabilities and damages whatsoever.*

    • Medical Information

    • Is the participant covered by family medical/hospital insurance?*

    • If yes, please indicate the following.
      Carrier/Plan Name:      
      Group & ID Number      
      Carrier Address & Phone Number      
      Name of Insured & Relationship to Camper      

    • MEDICAL INFO
      Name of Primary Doctor   *   
      Phone Number of Primary Doctor   *   
      Name of Dentist   *   
      Phone Number of Dentist   *   

    • We can accomodate some dietary restrictions but many of our tour sites generously provide lunches to our group and we will have limited input on those days. Does your camper have any dietary restrictions?*

    • Our Emergency Procedure

      We don't want to alarm you, but emergencies can happen and it's best to be prepared. In case of minor (non-life-threatening) emergency, we will first contact Parent 1 (as specified above) and then Parent 2. Occasionally in a true emergency situation, time is of the essence and 911 should be the first phone call. Following the 911 call, an ambulance may take a person to a hospital. Due to insurance, medical records, and specialties, families occasionally may be able to state their preference for which hospital.
    • SMI has the permission to take the following actions:*
    • Will your child need to take any medications during camp hours (If yes, another form will appear.)?*

    • Because the         requires medication during camp hours, I request that the medical staff at the Summer Manufacturing Institute be permitted to give this medication as directed below. I will provide the medication in an original pharmaceutically filled container whose label will clearly indicate the physician’s instructions for administration and physician’s name.   I understand that the Summer Manufacturing Institute will not administer medications not listed on this form or in their original pharmaceutically filled container.        

      Medication Name(s):      
      Dosage:      
      Time(s) of Day to be Given:      
      Possible Side Effects:      
      Who will administer your prescribed medication?:   
      Epi-Pen (Epinephrine):         

    • Should be Empty: