GIRLS SOAR! AVIATION DAY CAMP

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1 GIRLS SOAR! AVIATION DAY CAMP Saturday, March 19, :00am 3:00 pm American Airlines C.R. Smith Museum $25 Member/ $35 Non-Member Registration Take off with us at our 1 st Girls Soar Aviation Day Camp! The C.R. Smith Museum is working with Women Aviation professionals to encourage middle school girls to explore the world of aviation! Meet aviation professionals, tour facilities, perform experiments and activities and learn what it takes to be an aviator! Girls ages may register for a spot! Please complete the Registration, Student Profile, Medical Consent, General Release Forms available on our website. You may also print out completed registration packets and mail or bring with payment to the C.R. Smith Museum. Additional release forms, provided to you, might be necessary. Below is some general information about this day camp: Parents/students are responsible for transportation each day to and from the C.R. Smith Museum Camp begins at 9:00am and ends at 3:00pm. Campers may be dropped off between 8:45-9:00am and must be picked up by 3:15pm. Transportation for any outside field trips will be provided by a qualified transportation company Museum will provide snacks/ bottled water. Girls need to bring a sacked lunch. Each student will receive an Eagle Aviation t-shirt If you have any questions please call , or 1

2 REGISTRATION FORM (click inside textbox to type in information then form back as an attachment) CAMPER #1: GRADE: BIRTHDAY (MM/DD/YYYY): CONTACT INFORMATION: Parent s Name: Address: City: State: Zip Code: Home Phone Cell Phone T-SHIRT ADULT SIZE (place X in box next to desired size): Small Medium Large X-Large TUITION FOR ONE DAY: $25 MEMBERS/ $35 NON-MEMBERS CAMP DAY TIMES, SATURDAY MARCH 19 TH 9:00am- 3:00pm. Full and partial scholarships are available. Separate scholarship application required. Please contact for scholarship information. 2

3 Check Credit Card Cash *visit for membership information If a museum member, please provide the name that the membership is under: CREDIT CARD PAYMENTS For credit card payments, please enter in credit card information below: Name on Credit Card Credit Card # Expiration Date Security Code You may , Fax, Mail or Drop off Camp Registration Packets: Please Completed Registration forms to: Mail or Drop off forms to: American Airlines CR Smith Museum (Tuesday Saturday 9am 5pm) Attn: Lauren Giffin 4601 Hwy 360 at FAA Blvd Fort Worth, TX or Please Fax to: Proceeds from Eagle Aviation Camp benefit the educational programs of the CR Smith Museum, a nonprofit organization. Student Profile: Tell us about any special interests that you have relating to aviation. Do you have relatives or friends that work for the airline? 3

4 How did you hear about Girls Day Camp? In Case Of Emergency: Which parent should be contacted first in case of emergency? Emergency Contact: In the event that we are not able to reach the parent(s), please provide an emergency contact. Emergency Contact: Relationship to student: Home Phone: Cell Phone: Medical Consent NAME OF STUDENT: If it should become necessary, I hereby give my permission to the CR Smith Museum-Eagle Aviation Camp, and to its agents, to secure emergency medical treatment at the nearest medical facility for my minor child while under the care and supervision of agents of the Eagle Aviation Camp. Does your minor child possess any medical issues requiring special attention, such as Epilepsy, diminished hearing, diabetes, asthma, etc.; or require treatment or medication which would make it difficult for them to participate in the Eagle Aviation Camp activities? (Yes or No) If yes, please explain: 4

5 List all medications child is currently taking: Does your child have any dietary restrictions? Does your child suffer from motion sickness or fear of heights? General Release: (WE) (I), the undersigned, Name of Parent(s) or Guardian(s) of, a minor herein, do hereby give (our) (my) Name of student consent for said minor to participate in all academic activities, including but not limited to all field trips. (We) (I) do hereby remise, release, and forever discharge and do by this instrument, for (ourselves) (myself) heirs, executors, administrators and assigns, on behalf of (ourselves) (myself) and on behalf of said minor herein, remise release and forever discharge the Girls Soar Aviation Day Camp sponsors; all flight instructors, all pilots; all volunteers working with the Girls Soar Aviation Day Camp; from all and any manner of action and actions, cause and causes of action, suits, debts, dues, sums of money, damages, personal injury claims, wrongful deaths claims and all demands whatsoever, in laws, in admiralty or in equity, arising out of the Camp activities. 5

6 This release may not be changed orally. MODEL/INTERVIEWEE/ART RELEASE Name of Artist/Model/Interviewee I hereby grant to the Museum, a not-for-profit organization, and its licensees, agents, successors and assigns, the right, but not the obligation, to use my appearance, my name, moving or still photographs of me, recordings of my voice, and artworks or photographs I create while participating in the workshop, to the Museum for any educational, exhibition (physical or virtual), or promotional purpose, as at its sole discretion the Museum shall determine, including, but not limited to, display on television broadcasts, videos, the Museum s Web site, and all other forms of media now known or hereafter invented. Signature of Model/Interviewee/Artist Parent or Guardian Signature Date: Date: Release of Student I hereby give permission to release my child for pickup after class to the following alternate individuals: Name Relationship Telephone Name Relationship Telephone Note: Individuals named will be asked to show their ID before a student will be released to them. General Release I Hereby Give My Permission for to participate in all activities and field trips for the CR Smith Museum Girls Soar Aviation Day Camp. Parent / Guardian Signature Date 6

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