Registration Form

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Registration Form

Host: City by the Sea Museum

Email *

Child's Name *

Child's Age and Grade: *

Child's School: *

Parent Name: *

Parent Phone Number: *

Parent Email: *

Emergency Contact Name: *

Emergency Contact Phone Number: *

Please list any designated adults authorized to pick up your child upon camp dismissal each day: *

Please list any allergies or special medical concerns we should be aware of: *

Museum Membership Status (this allows us to verify correct pricing): *

I AM a member of the museum.

I am NOT a member, and I do not want to become a member.

I am NOT a member, but please tell me how to become one at a special rate of $65.

Will you need a scholarship for your child? *

Yes, full scholarship.

Yes, partial scholarship (I can pay for half of the cost for my child to attend).

No, I do not need a scholarship.

Required

For which camp are you registering your child for? *

Nature Neighbors, June 6-9, Grades K-2 ($65 non-members, $45 members)

Ocean Observers, June 20-24, Grades 3-5 ($100 non-members, $75 members)

Conservation Camp, July 11-15, Grades 6-8 (one day at Palacios Marine Agriculture Research Center, 100 Marine Center Dr) ($100 non-members, $75 members)

Marine Science Summer Program, July 18-22, Grades 9-12 (some days will also be at Palacios Marine Agriculture Research at 100 Marine Center Dr) ($100 non-members, $75 members)

Required

I am aware that if payment for camp is not made by the June 3rd, I will forfeit my child's spot in this camp. *

Yes

I am aware that I am responsible for organizing my child's transportation to and from the Palacios Pavilion and, if applicable, the Palacios Marine Agriculture Research Center (located at 100 Marine Center Dr) and that camp will begin at 10am (or 9am for those participating in upper grade level camps) and be dismissed at 12pm each day. *

Yes

Parents are invited to stay if they like as observers of the camp. Please let us know if you're planning on staying with your child during the camp. *

Yes

Maybe

Photo Release Form for a Minor (for participants under the age of 18). I, am the parent or legal guardian of (“my child”), a participant of the Spring Break Coastal Ecology Camp, a program by the City By the Sea Museum. I hereby consent to the publication and use of my child’s likeness (“Likeness”) for the purpose of promotion, publicity, advertising, or other manner or media by the City by the Sea Museum or any other representative authorized to act on behalf of the afore-mentioned entity. Likeness shall include, but not be limited to, photographs, sound and/or video recordings, films, broadcasts, brochures, publications, reports, web pages, promotional materials or any other audio-visual, electronic, printed, tangible work in any media or format, now known or hereafter to become known, and/or reproductions of any of these. I agree that the actual material involved is and shall continue to be the property of the City by The Sea Museum and that neither I, nor my child, shall have any right of review or approval regarding the use of my child’s likeness in such material. I hereby release and hold harmless, the City by the Sea Museum along with their respective employees, agents, affiliates, sponsors, or other representatives from any and all claims, demands, or causes of action arising out of the use of my child’s Likeness, in accordance with the terms of this release. I understand and agree that neither I, nor my child, will be compensated in any way for the use of my child’s Likeness by the City by the Sea Museum. *

By selecting this I am consenting to the above statement

By selecting this I am NOT consenting to the above statement

We never anticipate anything happening to any child or adult, but we are required to provide the following statement: I hereby give permission for my child to participate in the SUMMER CAMP provided by City by the Sea Museum, along with any/all activities associated with this week. I agree that my child is participating at his/her own risk, releasing City by the Sea Museum, its trustees, employees, volunteers, and agents, both now and in the future, from any accident, injury, illness or death which may occur as part of the program. In the event that my child is injured and requires emergency medical or dental treatment by a licensed practitioner, I hereby give my consent for the emergency transfer of my child to a hospital, and permission to the physician to secure proper treatment for and to order injection, anesthesia, x-rays, routine tests, treatment, transporting of child, surgery and to release reports necessary for insurance purposes for my son/daughter and that I will assume all financial responsibilities. It is understood that every effort will be made to contact me. I further understand that if my child is responsible for any damage done to any property, we as parents/guardians will be held responsible for my child’s actions. THIS PERMISSION SLIP MUST BE SIGNED BY A PARENT OR LEGAL GUARDIAN OVER THE AGE OF 21. *

By selecting this option, you are giving permission as stated above.

A copy of your responses will be emailed to the address you provided.

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