STEAM WORKS STUDIO - Summer Camps 2017 Registration

Camper One
Number of Camp Weeks for Camper One *
How many weeks of Camps?
Camper 1 Name *

First Name Last Name
Camper 1 Age *
Camper One Special Medical Info or Food Allergies
Describe if special requirement ex Uses EpiPen
Camp Week 1 Options *
Camp Week 1 (MORNING) *
Camp Week 1 (AFTERNOON) *
Camp Week 2 Options *
Camp Week 2 (MORNING) *
Camp Week 2 (AFTERNOON) *
Camp Week 3 Options *
Camp Week 3 (MORNING) *
Camp Week 3 (AFTERNOON) *
Camp Week 4 Options *
Camp Week 4 (MORNING) *
Camp Week 4 (AFTERNOON) *
Camp Week 5 Options *
Camp Week 5 (MORNING) *
Camp Week 5 (AFTERNOON) *
Camp Week 6 Options *
Camp Week 6 (MORNING) *
Camp Week 6 (AFTERNOON) *
Camp Week 7 Options *
Camp Week 7 (MORNING) *
Camp Week 7 (AFTERNOON) *
Camp Week 8 Options *
Camp Week 8 (MORNING) *
Camp Week 8 (AFTERNOON) *
Camp Week 9 Options *
Camp Week 9 (MORNING) *
Camp Week 9 (AFTERNOON) *
Camp Week 10 Options *
Camp Week 10 (MORNING) *
Camp Week 10 (AFTERNOON) *
Camp Week 11 Options *
Camp Week 11 (MORNING) *
Camp Week 11 (AFTERNOON) *
Camp Week 12 Options *
Camp Week 12 (MORNING) *
Camp Week 12 (AFTERNOON) *

Camper Two
Number of Camp Weeks for Camper Two *
How many weeks of Camps?
Camper Two Name *

First Name Last Name
Camper Two Age *
Camper Two Special Medical Info or Food Allergies
Describe if special requirement ex Uses EpiPen
Camp Week 1 Options *
Camp Week 1 (MORNING) *
Camp Week 1 (AFTERNOON) *
Camp Week 2 Options *
Camp Week 2 (MORNING) *
Camp Week 2 (AFTERNOON) *
Camp Week 3 Options *
Camp Week 3 (MORNING) *
Camp Week 3 (AFTERNOON) *
Camp Week 4 Options *
Camp Week 4 (MORNING) *
Camp Week 4 (AFTERNOON) *
Camp Week 5 Options *
Camp Week 5 (MORNING) *
Camp Week 5 (AFTERNOON) *
Camp Week 6 Options *
Camp Week 6 (MORNING) *
Camp Week 6 (AFTERNOON) *
Camp Week 7 Options *
Camp Week 7 (MORNING) *
Camp Week 7 (AFTERNOON) *
Camp Week 8 Options *
Camp Week 8 (MORNING) *
Camp Week 8 (AFTERNOON) *
Camp Week 9 Options *
Camp Week 9 (MORNING) *
Camp Week 9 (AFTERNOON) *
Camp Week 10 Options *
Camp Week 10 (MORNING) *
Camp Week 10 (AFTERNOON) *
Camp Week 11 Options *
Camp Week 11 (MORNING) *
Camp Week 11 (AFTERNOON) *
Camp Week 12 Options *
Camp Week 12 (MORNING) *
Camp Week 12 (AFTERNOON) *

Camper Three
Number of Camp Weeks for Camper Three *
How many weeks of Camps?
Camper Three Name *

First Name Last Name
Camper Three Age *
Camper Three Special Medical Info or Food Allergies
Describe if special requirement ex Uses EpiPen
Camp Week 1 Options *
Camp Week 1 (MORNING) *
Camp Week 1 (AFTERNOON) *
Camp Week 2 Options *
Camp Week 2 (MORNING) *
Camp Week 2 (AFTERNOON) *
Camp Week 3 Options *
Camp Week 3 (MORNING) *
Camp Week 3 (AFTERNOON) *
Camp Week 4 Options *
Camp Week 4 (MORNING) *
Camp Week 4 (AFTERNOON) *
Camp Week 5 Options *
Camp Week 5 (MORNING) *
Camp Week 5 (AFTERNOON) *
Camp Week 6 Options *
Camp Week 6 (MORNING) *
Camp Week 6 (AFTERNOON) *
Camp Week 7 Options *
Camp Week 7 (MORNING) *
Camp Week 7 (AFTERNOON) *
Camp Week 8 Options *
Camp Week 8 (MORNING) *
Camp Week 8 (AFTERNOON) *
Camp Week 9 Options *
Camp Week 9 (MORNING) *
Camp Week 9 (AFTERNOON) *
Camp Week 10 Options *
Camp Week 10 (MORNING) *
Camp Week 10 (AFTERNOON) *
Camp Week 11 Options *
Camp Week 11 (MORNING) *
Camp Week 11 (AFTERNOON) *
Camp Week 12 Options *
Camp Week 12 (MORNING) *
Camp Week 12 (AFTERNOON) *

Parent Name *

First Name Last Name
Parent E-mail *
Parent Cell Phone Number *
Release of Liability:

I hereby agree to be responsible for the conduct and actions of my child and release STEAM WORKS STUDIO and their employees/staff from any claims and demands that may occur during participation in classes which may arise from incidents/accidents involving my child, held on any premises where STEAM Works Studio conducts its business, to the extent allowed by law.
Signature *

Clear
Permission for Release of Content:

For STEAM WORKS STUDIO publications, website, and social media including Facebook and Twitter, for participants in classes, camps, and activities, I hereby consent that my child’s image, and likeness, as shown in videos, photographs, film, and/or electronics images and/or audio recordings of my child’s voice may be used by STEAM WORKS STUDIO for purposes of event documentation, media coverage, and promotion, and are the sole property of STEAM WORKS STUDIO.
Signature *

Clear
Sub-Total ($)
Multi Week Discount Coupon
Signing up for 5 weeks or more? Email or call to get unique coupon code
Coupon Discount ($)
Calculation
Total ${calculation}
Paying by check? *

No Yes

Payment Info

USD Amount to be paid

Summer Camp 2017 Registration