Summer Camp 2019

Summer Camp 2019 Registration (continued)
Did a friend invite you to join them for camp? Please enter their email below so they receive a referral discount. Don't forget to invite your friends! Receive a $10 discount if a friend registers! (Limit one per camper per summer.)
Referral family email
example@example.com
Member Savings
Member difference
Consider becoming a member today! You would save ${memberSavings} on just this registration! Membership is only $110 for a family of 4 (additional family members are only $12). For only ${memberDifference} more, your family of 4 will receive free admission year round to the MESS Hall and over 200 museums across the country, plus 20% off all other camps and workshops.
Add a membership?

Yes, please add a membership to my order to apply a 20% discount. No, not today.
Names for Membership

Please enter up to 4 family members in the same household (can include a grandparent, nanny, or other caregiver in membership). Please contact us to include additional members for $12 each.
Family Member 1

First Name Last Name
Grade Level (or Adult)
Please ensure that all members in the family are named individually, including the camper listed above and at least one adult.
Family Member 2

First Name Last Name
Grade Level (or Adult)
Family Member 3

First Name Last Name
Grade Level (or Adult)
Family Member 4

First Name Last Name
Grade Level (or Adult)
Would you like to add additional children, a grandparent, or another caregiver (nanny, babysitter)? Each additional person is $12. Please contact us with the additional names, and we will arrange payment.
Week-long camps selected
Single Day camps selected
Lunches Selected
Total for Camps
Pay by check/onsite credit card or Paypal? *

Check/Onsite credit card Online payment
Total for Camps Paypal

USD Camp Payment
Online payment for camps is processed via PayPal. A PayPal account is not required for payment. You may pay with credit or debit card or direct connection to your bank (limited banks participate in PayPal's program) without a PayPal account.
As an early-bird registrant, your child will receive a free MESS Hall t-shirt on the first day of their first camp. Please indicate the size and color you prefer. (We will have some spares, but this will ensure they get their first choice!)
Shirt size
Shirt Color
Parent/Guardian Information
Full Name *

First Name Last Name
Phone Number *
Alternate Phone Number

- Area Code Phone Number
E-mail *
example@example.com
Is there any information our instructors should know about your child? If yes, please describe. Note that this form is not HIPAA compliant, so please do not share medical information.
Informed Consent and Acknowledgement

In consideration of my child’s participation in programs provided by the Pensacola MESS Hall and/or its program partners, I indemnify and hold Pensacola MESS Hall and its affiliates, employees and agents harmless from and against any and all liability for negligence or medical expenses resulting from my child’s participation in such programs or other activities. I further release Pensacola MESS Hall and its affiliates, employees and agents from any and all negligence or other claims resulting from my child’s participation. I further understand that Pensacola MESS Hall and/or its program partners does not provide medical insurance coverage for my child and that any medical expenses incurred will be paid by either my own medical insurance or myself. I hereby grant permission for my child to participate in all activities including walking to sites off the Pensacola MESS Hall property.

I give permission for my child’s photo and/or likeness to be retained and used by Pensacola MESS Hall and/or its program partners without any remuneration or compensation.

Cancellation Policy & Tuition Refund

If a cancellation occurs…	Amount Refunded
5 or more calendar days before a program is scheduled to start (includes the weekend)	100% less $10 registration fee
1 to 4 calendar days before a program is scheduled to start (includes the weekend)	50% less $10 registration fee
Due to a no-show on the day the program is scheduled to start or subsequent days	0%

Confirmation

BY ACKNOWLEDGING AND SUBMITTING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AND BE EQUALLY BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

I UNDERSTAND THAT MY REGISTRATION IS NOT COMPLETE UNTIL I PAY THE AMOUNT DUE THROUGH PAYPAL OR ONSITE.
Should be Empty:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Week	AM Camp 9 AM - noon	Grade Level	PM Camp 1 PM - 4 PM	Grade Level
5/28 to 5/31	Science Sampler	1-6	Full Day Option	1-6
6/3 to 6/7	Rockin' Out	1-3	Code Academy	4-7
6/10 to 6/14	Inventor's Workshop	1-3	Full Day with FCAC
6/10 to 6/14	Inventor's Workshop	4-7	Full Day with FCAC
6/17 to 6/21	Light It Up!	1-3	Full Day with FCAC
6/17 to 6/21	Light It Up!	4-7	Full Day with FCAC
6/24 to 6/28	Lab Ratz	1-3	Lab Ratz	4-7
7/1 to 7/3	Science Sampler (3 days)	1-6	Full Day Option	1-6
7/8 to 7/12	Space Explorers	1-3	Space Explorers	4-7
7/15 to 7/19	Nature Ramble	1-3	Nature Ramble	4-7
7/22 to 7/26	Water Works	1-3	Engineering and Architecture	4-7
7/29 to 8/2	Robot Set Code	1-3	Robot Set Code	4-7

Summer Camp Registration 2019