Clone of Rural Up's FREE 2025 STEM Summer Camp- Laurel County (For Rising 5th-8th Graders)

Choose Location/Date:*

Mount Vernon: June 1-5, M-F, 9am-1pm, daily- Rockcastle County High School (1545 Lake Cumberland Rd, Mount Vernon, KY) (Registration Fee $30, scholarships available)Cumberland: June 1-5, M-F, 9am-1pm, daily - Location: Club 180 (716 School Road, Cumberland, KY) (No Registration Fee)McKee: June 8-12, M-F, 9am-1pm, daily - Location: Jackson County Public Library (338 N Main Street, McKee, KY) (Registration Fee $15, scholarships available)Manchester: June 15-18, M-Th, 9am-2pm, daily - Location: Clay County Middle School (239 Richmond Rd, Manchester, KY) (Registration Fee $30, scholarships available, Thompson Scholars are free)Harlan: June 15-19, M-F, 9am-1pm, daily - Location: Harlan Middle School (420 E. Central St., Harlan, KY) (Registration Fee $30, scholarships available)London: June 29-July 2, M-Th, 9am-2pm, daily - Location: Kentucky Highlands Innovation Center (440 Old Whitley Rd, London, KY) (Registration Fee $30, scholarships available)Barbourville: July 13-17, M-F, 9am-1pm, daily - Location: Union Commonwealth University (Edward H. Black Technology Center, 310 College St, Barbourville, KY) (Registration Fee $30, scholarships available)

First Name*

Last Name*

Preferred Name

Address*

City*

State*

Zip*

Camper's County of Residence:*

Camper's Gender*

MaleFemale

Birth Date*

MonthDayYear

School attending this Fall:*

Grade entering in the Fall*

Parent/Legal Guardian*

Relation*

Email *

Cell Phone*

Area CodePhone Number

(Other) Phone

Area CodePhone Number

Parent /Legal Guardian 2

Relation 2

Cell Phone 2

Area CodePhone Number

(Other) Phone 2

Area CodePhone Number

Emergency Contact Name(if parent or guardian is not available)*

First and Last Name

Phone Number*

Area CodePhone Number

Camper Release (List anyone, including parents, relatives and friends), to whom your camper may be dropped off and picked up by throughout the week)*

Does the camper have any food allergies, or dietary restrictions.*

Is there anything you’d like us to know about your camper’s learning needs or any accommodations that would help them have a great experience?*

How did you hear about Rural Up's STEM Camp?

Why are you and/ or the camper interested in this camp?

What has the student created recently that they are proud of? (It does not have to be STEM related.)

I grant Rural Up, its representatives, and employees the right to take photographs, videos, use statements or biographical information of my student pertaining to Rural Up services. I authorize Rural Up, its assigns and transferees to copyright, use and publish the same in print and/or electronically, I agree that Rural UP may use such photographs of my student with or without their name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. We waive our right to inspect or approve the finished products. I also agree that I, nor my student, will not be compensated for the use of my name, photograph, videos, or biographical information. I hereby release Rural Up from all and any liability arising out of the exercise of the rights granted in this release.

Select one:*

Yes, I give consentNo, I do not give consent

Signature*

Signature Date*

Date

I hereby release, hold harmless, defend and indemnify Rural Up, Inc. from any and all damages, injuries, and causes of action which may accrue to or be asserted by me or any minor child of mine arising directly or indirectly from my participation or my minor child's participation in Rural Up, Inc.'s camp.

Signature*

Date of Signature*

Date

Rural Up's 2026 Summer STEM Explorer Camp Registration Form

Choose a Camp:

Camper's Name

Camper's Information

Parent or Legal Guardian Information

Emergency Contact(s)

Other Information

Publicity Release

Liability and Procedural Agreement

Registration Fee