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The Innovation Station Registration Form

Welcome to the Innovation Station Summer Camp! Thank you for registering your child for an exciting summer of learning, creativity, and fun! Our camp is designed to inspire and to engage with morning academics, hands-on STEM activities and so much more. We provide free breakfast, lunch, and snack daily.   If your child has a medical condition, please be sure to complete the medical section of this form. In order to reserve your spot for this program, you must complete this form and pay the minimum deposit of $50.00. 
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  • 1
    Complete a different form for each scholar.
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  • 2
    Month-Day-Year
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    Pick a Date
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  • 3
    Type the grade the scholar will be in for the upcoming school year.
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  • 4
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  • 5
    Home Address
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    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
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    • Angola
    • Anguilla
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    • Rwanda
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    • Saint Helena
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    • Togo
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    • Tonga
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    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
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    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
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    • Uruguay
    • Uzbekistan
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    • Vatican City
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    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
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    • Other
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  • 6

    Parent/Guardian Information

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  • 11

    Emergency Information

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  • 13
    Please Select
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    • Mother
    • Father
    • Grandparent
    • Aunt
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    • Sibling
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    • Other
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  • 14
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  • 15
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  • 16
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  • 17
    Submit additional medical information during orientation.
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  • 18
    Once your application has been reviewed, you will receive a link to pay the $50 registration fee.
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  • 19

    ALERT-PLEASE READ THIS ENTIRE PAGE!

     

    Medical Release and Authorization 

    I acknowledge that my scholar is physically able to participate in all camp activities. I understand that, The Innovation Station, staff will take all necessary precauations to ensure my scholar's safety. In the event of an emergency, I authorize the camp staff to seek medical treatment for my child if I cannot be reached. 

    If my scholar has any serious medical conditions, allergies, or special medical needs, I agree to provide appropriate documentation and instructions during the summer camp orientation. I understand that failure to provide this information may affect my scholar's participation in certain activities. 

     Sign below for medical release and authorization. 

     

     

     

     

     

     

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  • 20
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  • 21

    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.

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  • 22
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  • 23
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    Pick a Date
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  • 24
    Once your applicaiton has been reviewed, you will receive a link to pay the registration fee.
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Clone of The Innovation Station Registration Form 2026
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