(STEaM) Summer Camp 2014 Where Nature s Wisdom Powers Human Innovation

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1 STEaM Camp Camper Registration Form Camps Filled First Come, First Serve Science, Technology, Engineering, (Arts) & Math (STEaM) Summer Camp 2014 Where Nature s Wisdom Powers Human Innovation Clint Small Middle School Green Tech Academy is proud to announce the 3 rd year of engaging STEaM Summer Camps for students entering 3 rd -8 th grades! Week long STEaM Camps offer a fun, safe, engaging educational environment to learn, explore, build self confidence, and be creative. All fun filled STEaM sessions are led by certified Austin ISD Science, Technology, Engineering, Arts, and Math teachers. Register Today! Turn in Your Registration Packet and Payment to the Small Middle School Main Office either in person or by mail. Camps will be filled first come, first serve. You will receive confirmation via that we have received your registration form and payment. Address:, Fax: Phone: Camp Director: Melissa Dunaway mdunaway@austinisd.org Each Camp Includes: STEaM Activities Robotics/Engineering Challenges Mad Science Labs Destination Imagination Math Games & Puzzles Games & Rec Fine Arts Computer Lab Field Trip Pool Time Lunch/Snack Provided STEaM Camp 2014 Ages: Going into 3 rd -8 th Grade Tuition: $300 per week Non-Refundable Deposit Due at Registration: $100 per week Camp Hours: 8am-4pm Free Early Drop Off: 7:30am Free Late Pick Up: 4-5:30pm Theme Week 1: (roller coasters, engineering & more!) Week 2: To Infinity and Beyond (Astronomy & Space Travel Challenge) Week 3: Crazy Chemistry (funky lab experiments) Week 4: (forensic science) Week 5: Green by Your Design ( green city, product development) Field Trip* (Proposed) Bowling GattiTown Mayborn Planatarium Stunt Ranch Main Event (Laser Tag) Ecology Action Austin Park and Pizza

2 Time Sample Weekly Schedule Monday Tuesday Wednesday Thursday Friday 7:30-8am Early Check In Early Check In Early Check In Early Check In Early Check In 8-8:25 Check In & Games Check In & Games Check In & Games Check In & Games Check In & Games 8:30-9:45 STEM Games and Rec STEM Games and Rec 9:50-11:20 Fine Art Computer Fine Art Fun Activity Field Computer 11:25-11:55 Service Learning Math Games and Puzzles CATCH Activity Trip STEM Career Guest Speaker 11:25-12: :30 Lunch Lunch Lunch Lunch Lunch 12:40-1:10 12:30-1:45 Robotics Mad Science Lab Robotics Mad Science Lab Pool prep/expectations 1:10-1:30 1:50-3:20 Destination Imagination Engineering Challenge Destination Imagination Engineering Challenge Board 1:45 3:25-3:55 Career exploration Career exploration Career Exploration Career Exploration Deep Eddy Pool 2:00-4:00 4:00 Snack & Check Snack & Check Out Snack & Check Out Snack & Check Out Check 4:15 Out 4-5:30 Late Pick Up Late Pick Up Late Pick Up Late Pick Up Late Pick Up Lunch is provided daily in the school cafeteria. Healthy snacks are provided once per day. Students may bring their own food and/or snack. Microwave ovens are available in the school cafeteria. Some fieldtrips may require a sack lunch. Each student will also receive a reusable STEM Camp water bottle and STEM Camp t-shirt! The AISD Student Code of Conduct will be enforced. A copy is available in the Small MS front office or available online at Students who are dismissed from camp due to misbehavior will forfeit registration & tuition fees. The AISD Dress Code will be enforced. A copy is available in the Small MS front office or available online at Thursday is field trip day! Campers must wear their camp T-shirt. If you forget your camp t-shirt, a replacement fee of $10.00 will be charged. Field trip activity tickets are included in your camp tuition. Sending your child with extra spending money is optional, but camp staff cannot hold money for campers. Friday is pool day! Campers must participate in service learning projects on the school grounds and bring a change of clothes and sunscreen as well as a bathing suit for pool time. Staff members are certified in CPR, first aid, and water safety. Activities: Campers will be divided into groups based on age for the morning activities. Campers will be divided into groups depending on experience/interest in robotics for the afternoon. Students will engage in activities in the areas of STEM, robotics, fine arts, Destination Imagination, engineering challenges, Mad Science labs, and outside recreation. Activities are led by certified teachers!

3 STEaM Camp Camper Registration Form Camps Filled First Come, First Serve Science, Technology, Engineering, (Arts) & Math (STEaM) Summer Camp 2014 Where Nature s Wisdom Powers Human Innovation Register TODAY! Camper #1 s Name: School: Grade Level: M or F D.O.B.: / / Please check the week(s) that your child will attend camp: Week One: Week Two: To Infinity and Beyond Week Three: Crazy Chemistry Week Four: Week Five: World Architect T-shirt size (indicate quantity): One shirt per child provided with tuition. Additional shirts are $ CS (6-8) CM (10-12) CL (14-16) AS AM AL Camper #2 s Name: School: Grade Level: M or F D.O.B.: / / Please check the week(s) that your child will attend camp: Week One: Week Two: To Infinity and Beyond Week Three: Crazy Chemistry Week Four: Week Five: World Architect T-shirt size (indicate quantity): One shirt per child provided with tuition. Additional shirts are $ CS (6-8) CM (10-12) CL (14-16) AS AM AL

4 STEaM Camp Camper Registration Form Camps Filled First Come, First Serve STEM Camp Registration Information: Child(ren) s Name(s): Address: City: Zip: Mother s Name: Father s Name: Home #: Work #: Cell #: Home #: Work #: Cell #: Name, Address, and Phone # of emergency contact if parents cannot be reached: I authorize Small Middle School to allow my child(ren) to leave with ONLY parents listed above and the following persons: Name: _ Phone #: Name: _ Phone #: Name: _ Phone #: If possible, my child would like to be in a group with: Release of Liability I/We assume responsibility and waive any claim for compensation for injury incurred by my/our child(ren) while in camp and hereby agree to indemnify or hold harmless Small Middle School and the STEM Camp staff against any and all claims, which may arise from an injury to my/our child(ren) while participating in the program. SIGNATURE OF PARENT OR LEGAL GUARDIAN: _DATE: / / I hereby give my consent for Small Middle School to provide transportation to and from field trips and the pool. SIGNATURE OF PARENT OR LEGAL GUARDIAN: _DATE: / / Medical Information: Child s Physician: _ Phone #: Emergency Care Facility: _ Phone #: Other: Any known medical problems/allergies: _

5 Medication Will your child need to have medication administered at camp? YES NO If yes, medication dosage time *Note: If your child will need medication administered while at camp, there will be an additional Medication Administration Form for you to fill out when you check your child in the first day. SIGNATURE OF PARENT OR LEGAL GUARDIAN: _DATE: / / Parent Initials: I hereby give my consent for my child(ren) to participate in field trips. I hereby give my consent for my child(ren) to participate in water activities. I hereby give my consent for my child(ren) to eat lunch daily. I hereby give my consent for my child(ren) to eat a snack daily. I hereby give my consent for my child(ren) to appear in pictures used on the school and/or camp website. Names will not be used. I hereby give my consent for my child(ren) to appear in pictures used in camp promotional materials. Names will not be used. Swim level (circle one): 3-4 feet (shallow end of pool) 5 feet & diving board (deep end of pool) Special Comments: SIGNATURE OF PARENT OR LEGAL GUARDIAN: DATE: / / Robotics Survey (to assist with planning): Please indicate your child s level of knowledge in Robotics: Novice: Very little experience Intermediate: Engineering (building) robots and some programming Advanced: Programming and some engineering (building) Please indicate your child s interest in Robotics: My child would prefer to explore with the legos My child is interested in engineering robots My child is interested in programming robots

6 TUITION PAYMENT STEM Camp 2014 Tuition: $300/week Non-Refundable Deposit Due at Registration: $100 per week All Tuition Must Be Paid in FULL by June 1 st FORMS OF PAYMENT/DEPOSITS/CANCELLATION POLICY: Please make checks out to Small Middle School. If not paying in full, a non-refundable deposit of $100 per week towards your camp tuition is required upon registration. Cancellation after June 1 st (but at least 2 weeks before camp) will result in refund of camp tuition minus deposit. Cancellation less than 2 weeks before the start of your camp date will result in forfeiture of all payment. Amount Enclosed: $ Amount Still Owed by June 1 ST : $ SCHOLARSHIPS: A limited number of partial and full STEaM Camp scholarships are available! To be eligible for a STEM Camp scholarship, your child must: 1) be headed for CSMS or currently attending CSMS, AND 2) be on free or reduced lunch at school. Note: Scholarship notifications will be made via from May 1 st -15 th. I am applying for a partial scholarship. I am applying for a full scholarship. My child is on free or reduced lunch (check one). I am able to pay and have enclosed $ of the $300 tuition (number can be $0). REQUEST FOR SCHOLARSHIP CONSIDERATION: Please number the camp weeks in order from 1 (1 st choice) to 5 (5 th choice). Week One: Week Two: To Infinity and Beyond Week Three: Crazy Chemistry Week Four: Week Five: Green by Design