Future City Camp (July 18-22), 6th – 8th grades, Rolla

Description

Future City
6th – 8th grades
July 18-22
12:20 – 4 pm

Specially designed for rising 6th-8th grade students interested in how cities work! Explore the importance of city design by building a model with a moving part, by virtual design using Sim City software to address a thematic problem and by area field trips. This camp is designed to prepare competition-aged students for the national Future City competition.

Maximum Registration: 8 students

IMPORTANT: Before your registration can be considered complete, you must fill the registration form below. Please be sure the number of students you’re registering on the form matches the number you’re paying for.

Registration Form - Future City June 13 - 17

Registration form for Future City June 13 - 17

How many students are you paying for and registering at this time? *

Student #1

Student Name *

Student Name

First

Last

Student Birthdate *

Student Age (at time of class/event) *

Student Phone *

Is the student's phone number the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's number in the next section)

Student Address *

Student Address

City

State

Zip/Postal

Country

Is the student's address the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's address in the next section)

Legal Guardian Name *

Legal Guardian Name

First

Last

Legal Guardian Phone *

Legal Guardian Address *

Legal Guardian Address

City

State

Zip/Postal

Additional Emergency Contact Name *

Additional Emergency Contact Name

First

Last

Besides the legal guardian listed above, is there anyone else you 'd like to list as an emergency contact?ional person listed as well? *

Yes, there is someone else,. I'll list them below.

No, just the legal guardian listed above is fine

Additional Emergency Contact Relation to Student *

Additional Emergency Contact Phone *

Does your student have any allergies we should be aware of? *

Yes

Allergies *

List any allergies your child has and please list the reactions to those allergies:

Does your child have an EpiPen? *

Yes

Is your child able to able to administer the EpiPen themselves? *

Yes

Special accommodations or anything else we should know

List any special accommodations needed for your child or anything else you feel is beneficial for us to know. Or feel free to leave blank if there are none.

Student #2

Student Name *

Student Name

First

Last

Student Birthdate *

Student Age (at time of class/event) *

Student Phone *

Is the student's phone number the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's number in the next section)

Student Address *

Student Address

City

State

Zip/Postal

Country

Is the student's address the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's address in the next section)

Legal Guardian Name *

Legal Guardian Name

First

Last

Legal Guardian Phone *

Legal Guardian Address *

Legal Guardian Address

City

State

Zip/Postal

Besides the legal guardian listed above, is there anyone else you 'd like to list as an emergency contact?ional person listed as well? *

Yes, there is someone else,. I'll list them below.

No, just the legal guardian listed above is fine

Additional Emergency Contact Name *

Additional Emergency Contact Name

First

Last

Additional Emergency Contact Relation to Student *

Additional Emergency Contact Phone *

Does your student have any allergies we should be aware of? *

Yes

Allergies *

List any allergies your child has and please list the reactions to those allergies:

Does your child have an EpiPen? *

Yes

Is your child able to able to administer the EpiPen themselves? *

Yes

Special accommodations or anything else we should know

List any special accommodations needed for your child or anything else you feel is beneficial for us to know. Or feel free to leave blank if there are none.

Student #3

Student Name *

Student Name

First

Last

Student Birthdate *

Student Age (at time of class/event) *

Student Phone *

Is the student's phone number the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's number in the next section)

Student Address *

Student Address

City

State

Zip/Postal

Country

Is the student's address the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's address in the next section)

Legal Guardian Name *

Legal Guardian Name

First

Last

Legal Guardian Phone *

Legal Guardian Address *

Legal Guardian Address

City

State

Zip/Postal

Besides the legal guardian listed above, is there anyone else you 'd like to list as an emergency contact?ional person listed as well? *

Yes, there is someone else,. I'll list them below.

No, just the legal guardian listed above is fine

Additional Emergency Contact Name *

Additional Emergency Contact Name

First

Last

Additional Emergency Contact Relation to Student *

Additional Emergency Contact Phone *

Does your student have any allergies we should be aware of? *

Yes

Allergies *

List any allergies your child has and please list the reactions to those allergies:

Does your child have an EpiPen? *

Yes

Is your child able to able to administer the EpiPen themselves? *

Yes

Special accommodations or anything else we should know

List any special accommodations needed for your child or anything else you feel is beneficial for us to know. Or feel free to leave blank if there are none.

Student #4

Student Name *

Student Name

First

Last

Student Birthdate *

Student Age (at time of class/event) *

Student Phone *

Is the student's phone number the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's number in the next section)

Student Address *

Student Address

City

State

Zip/Postal

Country

Is the student's address the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's address in the next section)

Legal Guardian Name *

Legal Guardian Name

First

Last

Legal Guardian Phone *

Legal Guardian Address *

Legal Guardian Address

City

State

Zip/Postal

Besides the legal guardian listed above, is there anyone else you 'd like to list as an emergency contact?ional person listed as well? *

Yes, there is someone else,. I'll list them below.

No, just the legal guardian listed above is fine

Additional Emergency Contact Name *

Additional Emergency Contact Name

First

Last

Additional Emergency Contact Relation to Student *

Additional Emergency Contact Phone *

Does your student have any allergies we should be aware of? *

Yes

Allergies *

List any allergies your child has and please list the reactions to those allergies:

Does your child have an EpiPen? *

Yes

Is your child able to able to administer the EpiPen themselves? *

Yes

Special accommodations or anything else we should know

List any special accommodations needed for your child or anything else you feel is beneficial for us to know. Or feel free to leave blank if there are none.

Student #5

Student Name *

Student Name

First

Last

Student Birthdate *

Student Age (at time of class/event) *

Student Phone *

Is the student's phone number the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's number in the next section)

Student Address *

Student Address

City

State

Zip/Postal

Country

Is the student's address the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's address in the next section)

Legal Guardian Name *

Legal Guardian Name

First

Last

Legal Guardian Phone *

Legal Guardian Address *

Legal Guardian Address

City

State

Zip/Postal

Besides the legal guardian listed above, is there anyone else you 'd like to list as an emergency contact?ional person listed as well? *

Yes, there is someone else,. I'll list them below.

No, just the legal guardian listed above is fine

Additional Emergency Contact Name *

Additional Emergency Contact Name

First

Last

Additional Emergency Contact Relation to Student *

Additional Emergency Contact Phone *

Does your student have any allergies we should be aware of? *

Yes

Allergies *

List any allergies your child has and please list the reactions to those allergies:

Does your child have an EpiPen? *

Yes

Is your child able to able to administer the EpiPen themselves? *

Yes

Special accommodations or anything else we should know

List any special accommodations needed for your child or anything else you feel is beneficial for us to know. Or feel free to leave blank if there are none.

Student #6

Student Name *

Student Name

First

Last

Student Birthdate *

Student Age (at time of class/event) *

Student Phone *

Is the student's phone number the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's number in the next section)

Student Address *

Student Address

City

State

Zip/Postal

Country

Is the student's address the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's address in the next section)

Legal Guardian Name *

Legal Guardian Name

First

Last

Legal Guardian Phone *

Legal Guardian Address *

Legal Guardian Address

City

State

Zip/Postal

Besides the legal guardian listed above, is there anyone else you 'd like to list as an emergency contact?ional person listed as well? *

Yes, there is someone else,. I'll list them below.

No, just the legal guardian listed above is fine

Additional Emergency Contact Name *

Additional Emergency Contact Name

First

Last

Additional Emergency Contact Relation to Student *

Additional Emergency Contact Phone *

Does your student have any allergies we should be aware of? *

Yes

Allergies *

List any allergies your child has and please list the reactions to those allergies:

Does your child have an EpiPen? *

Yes

Is your child able to able to administer the EpiPen themselves? *

Yes

Special accommodations or anything else we should know

List any special accommodations needed for your child or anything else you feel is beneficial for us to know. Or feel free to leave blank if there are none.

Student #7

Student Name *

Student Name

First

Last

Student Birthdate *

Student Age (at time of class/event) *

Student Phone *

Is the student's phone number the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's number in the next section)

Student Address *

Student Address

City

State

Zip/Postal

Country

Is the student's address the same as their legal guardian's? *

Yes, it's the same

No (you'll be asked to enter the legal guardian's address in the next section)

Legal Guardian Name *

Legal Guardian Name

First

Last

Legal Guardian Phone *

Legal Guardian Address *

Legal Guardian Address

City

State

Zip/Postal

Besides the legal guardian listed above, is there anyone else you 'd like to list as an emergency contact?ional person listed as well? *

Yes, there is someone else,. I'll list them below.

No, just the legal guardian listed above is fine

Additional Emergency Contact Name *

Additional Emergency Contact Name

First

Last

Additional Emergency Contact Relation to Student *

Additional Emergency Contact Phone *

Does your student have any allergies we should be aware of? *

Yes

Allergies *

List any allergies your child has and please list the reactions to those allergies:

Does your child have an EpiPen? *

Yes

Is your child able to able to administer the EpiPen themselves? *

Yes

Special accommodations or anything else we should know

List any special accommodations needed for your child or anything else you feel is beneficial for us to know. Or feel free to leave blank if there are none.

Student #8

Student Name *

Student Name

First

Last

Student Birthdate *

Student Age (at time of class/event) *

Student Phone *

Is the student's phone number the same as their legal guardian's? *

Yes, it's the same

Future City Camp (July 18-22), 6th – 8th grades, Rolla

Subtotal:

Add-ons total:

Total:

Description

Registration Form - Future City June 13 - 17

Student #1

Student #2

Student #3

Student #4

Student #5

Student #6

Student #7

Student #8