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Camp Explorations Registration Form 2022

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Camp Explorations Registration Form 2022

Complete one set of forms for each child. You may make copies of this form or print additional copies from our website. All forms and payment must be completed in order to process your registration. PLEASE TYPE OR PRINT LEGIBLY.

Participant Name: Nickname:

Age:

Kids are placed in age appropriate groups. We make every effort to accommodate requests for campers to be in the same group as a friend, though requests are not guaranteed. Please indicate the name(s) of the friends.

Birthdate: Gender: Male

Female

Contact Information for First Parent/Guardian Contact Information for Second Parent/Guardian

Name: Name:

Relation to Camper: Relation to Camper:

Home Address:

Work Phone:

Cell Phone:

Email Address:

(Required for confirmation and receipt)

Home Address:

Work Phone:

Cell Phone:

Email Address:

Cancellation Policy

A $25 cancellation fee is applied to all refunds. Refunds will be given if requested at least 14 days before your camp start date. No refunds will be given if requested after 14 days of your camp start date. Please notify the camp office in writing for any cancellation requests. In the event that the child does not meet thehealth requirements in the Camp

Please check this box if you would like to be added to the Pick Up Authorization Form (page 5). We do not automatically add you.

Please check this box if you would like to be added to the Pick Up Authorization Form (page 5). We do not automatically add you.

T-Shirt Size: Youth XS (2-4) S (6-8) M (10-12) L (14-16) Adult S M L XL Completed Grade as of 6/2022:

We will confirm your registration by email and then contact you for payment. Do not send payment information by email.

Processing Fee

A $15 processing fee will be assessed for any requested registration changes or cancellations. Please double check your schedule and application before submitting Friend Request Name(s):

Adventure Sessions

Please indicate if someone who is not listed on the page should be contacted for payment or sent the camp information and include their contact information.

Are you a Museum member? Yes No

How did you hear about

Camp Explorations? Museum email U-M email Facebook Ann Arbor Observer Other

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Camp Explorations Selection Form 2022

Select the weeks your child will be attending and note the cost in the column to the right. When you are

finished making your selections, add all the items and enter the amount on the Total Amount Due for All Camps line below. Your registration is not complete without payment.

Total Amount Due for All Camps: $__________

Participant Name:

*No camp on Monday, July 5.

Sessions for completed Grades K-5

Adventure AM Sessions (8:00 a.m. - 12:00 p.m.)

1. PARTYcle Physics ...Monday, June 20-Friday, June 24 ...$195...

2. Junior Archaeologist ...Monday, June 27-Friday, July 1 ...$195...

3. Try It! Science...Tuesday, July 5-Friday, July 8* ...$155...

4. Dinosaur Mysteries ...Monday, July 11-Friday, July 15...$195...

5. Astrononauts in Training...Monday, July 18-Friday, July 22...$195...

6. Detective Academy...Monday, July 25-Friday, July 29...$195...

7. Adventures in Archaeology...Monday, August 1-Friday, August 5...$195...

8. Best of Camp Explorations...Monday, August 8-Friday, August 12...$195...

PM Sessions (1:00 p.m.-4:00 p.m.)

1. Solar System Safari...Monday, June 20-Friday, June 24 ...$185...

2. Outdoor Explorers ...Monday, June 27-Friday, July 1 ...$185...

3. Digging Up the Past...Tuesday, July 5-Friday, July 8* ...$145...

4. Animal Superheros...Monday, July 11-Friday, July 15 ...$185...

5. Chemical Chaos ...Monday, July 18-Friday, July 22...$185...

6. Inventor’s Workshop...Monday, July 25-Friday, July 29...$185...

7. Fantastic Fossils ...Monday, August 1-Friday, August 5...$185...

8. “Ology” Camp...Monday, August 8-Friday, August 12...$185...

Aftercare (4:00-6:00 p.m.)

1. Aftercare Week 1 ...Monday, June 210Friday, June 24 ...$75...

2. Aftercare Week 2...Monday, June 27-Friday, July 1 ...$75...

3. Aftercare Week 3 ...Tuesday, July 5-Friday, July 8* ...$60...

4. Aftercare Week 4...Monday, July 11-Friday, July 15...$75...

5. Aftercare Week 5 ...Monday, July 18-Friday, July 22 ...$75...

6. Aftercare Week 6...Monday, July 25-Friday, July 29 ...$75...

7. Aftercare Week 7 ...Monday, August 1-Friday, August 5...$75...

8. Aftercare Week 8...Monday, August 8-Friday, August 12...$75...

Lunch is supervised for those in an all-day session.

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Participant Name:

Parents and legal guardians are responsible for carefully reviewing all program materials and for selecting programs that are appropriate for their child. Information regarding U-M sponsored programming for children is available at childrenoncampus.umich.edu.

I understand that my child’s participation in the Camp Explorations Summer Program is voluntary and that as I condition of my child’s participation, I agree to comply with all Camp requirements including, but not limited to: (a) accurately completing all registration forms in a timely manner, (b) ensuring that my child is aware of the Camp’s standards of conduct; (c) and immediately notifying the Camp Director of any concerns related to the health, safety or security of my child, other participants or Camp staff.

I understand that as part of my child’s participation in the Camp that there are dangers, hazards and inherent risks to which my child may be exposed, including the risk of serious physical injury, temporary or permanent disability, and death, as well as economic and property loss. I further realize that participating in the Camp may involve risks and dangers, both known and unknown, and I have chosen to allow my child to take part in the Camp. Therefore, I, and on behalf of my child, have determined that it is reasonable to accept all risk of injury, loss of life or damage to property arising out of training, preparing, participating, and traveling to or from the Camp and I do voluntarily accept and assume those risks. I release the University of Michigan, its Board of Regents, Administration, Faculty, Staff, Graduate Students, and all other officers, directors, employees, volunteers and agents from any claims or liability arising from my child’s participation in the Camp, provided that such claim is not due to the gross and sole negligence of the released parties.

In the event of an accident or serious illness, I authorize representatives of the University to obtain medical treatment for my child. I hold harmless and agree to indemnify the University from any claims, causes of action, damages and/or liabilities, arising out of or resulting from said medical treatment. I further agree to accept full responsibility for any and all expenses, including medical expenses that may derive from any injuries to my child that may occur during his/her participation in the Camp.

I also agree to indemnify the University and all of its employees and agents from any financial obligations or liabilities that my child may cause while participating in the Camp, including attorney’s fees and court costs resulting from his/her misconduct, errors, or omissions.

I acknowledge that University employees have undergone criminal background checks, but other participants of the event may not have undergone background check screening. As such, the University makes no assertions or assurances with respect to other participants.

This Agreement is governed by and construed under the laws of the State of Michigan without regard for principles of choice of law. Any claims, demands, or actions arising under this Agreement must be brought in the Michigan Court of Claims or a court with applicable subject matter jurisdiction sitting in the state of Michigan court with appropriate subject matter jurisdiction.

Camp Explorations Participation Agreement & Waiver Form

TRANSPORTATION AUTHORIZATION

I understand that my child will travel to and from all Camp events under the supervision of Camp staff. I agree to allow my child to use the U-M bus system (a blue bus) or travel by foot to locations on or off the U-M campus.

Parent/Guardian Name:

Parent/Guardian Signature: Date:

I agree that the terms and conditions of this Agreement are binding on my representatives, heirs and assigns.

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Participant Name:

The Camp has established rules and standards of conduct for all Participants. It is the responsibility of the Parent/

Legal Guardian and the Participant to review the Program rules and standards of conduct. Dismissed Particpants are not eligible for a refund of any fees or expenses. The Parent/Legal Guardian is responsible for all costs associated with removing the Participant from the Program due to his/her misconduct, including but not limited to transporation costs to return the Participant home.

We strive to create an environment that is welcoming, inclusive, and inspires curiosity for all campers. For this reason, campers must be able to conduct themselves in an appropriate manner.

Maintain appropriate language and actions Hands to themselves

Respectful language to fellow campers and camp staff Stay with their group

Listen to camp staff and follow directions

If your camper is struggling, we will have a quiet, friendly space that campers can take a break and calm down or

recharge before returning to their group. We do reserve the right to remove any camper that repeatedly cannot meet these expectations.

I understand that my child will be subject to the rules and standards of conduct of the Program and the University of Michigan. I further understand that my child’s violation of the rules and standards of conduct or failure to comply with the reasonable direction or Program Staff may result in my child’s dismissal from the Program. I accept responsibility for all costs associated with removing my child from the Program, including by not limited to transporation costs to return the Participant home.

Camp Explorations Participant Conduct Agreement Form

PARENT/LEGAL GUARDIAN AGREEMENT

Parent/Guardian Name:

Parent/Guardian Signature: Date:

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Camp Explorations Photo Release & Pick Up Authorization

MEDIA, PHOTO & VIDEO RELEASE

Please check one box.

Yes- Media, Photo and Video Authorization

I understand that during the course of my child’s participation in the U-M Museum of Natural History Summer Camp Program, that the Program, and those acting with the Program’s permission or authority, may capture my child’s name, likeness, image, or voice in photographic, audio, video, digital or other recording forms (“Recordings”). I give my permission for the Program to use those recordings or works produced by my child for promotional, commercial, informational, and educational purposes in any and all media (including the Internet) now existing or hereafter devised, for any purpose consistent with the Program’s mission. I understand that I will not have an opportunity to review or approve uses of the Recordings or Works.

I recognize that the U-M Museum of Natural History, through the Board of Regents of the University of Michigan (“University”), holds the copyright in all Recordings. I understand that neither my child nor I will receive payment or any other compensation for taking or use of any Recordings of Works created as a result of my child’s participation in the Camp.

I release, indemnify and hold harmless the University from and against all liability, actions, debts, claims and demands of every kind whatsoever to the taking or use of the Recordings or Works of my child.

No- Media, Photo and Video Authorization

I do not grant permission to the University of Michigan Museum of Natural History Summer Camp Program to take or use my child’s name, likeness, image, or voice in any form or to use work produced by child for any reason unless necessary for the administration of the Program while my child is participating in the Program.

Please list any individual who is authorized to pick up your camper(s). Please check the box on page 1 if you would like the parent/guardians listed to be added to the authorized pickup list. Each authorized person must be at least 16 years of age. The above-named Participant will not be permitted to leave Camp with anyone who is not listed below. Authorized individuals must pick up children in person and may be requested to show identification to Camp staff when picking up a Participant. Participants will not be released to persons who fail to provide acceptable identification upon request.

I authorize the following responsible person to pick up my child from the aforementioned Camp activities:

PICK UP AUTHORIZATION

AUTHORIZED PERSON PHONE NUMBER RELATIONSHIP TO CHILD

Parent/Guardian Name:

Participant Name:

Camp Explorations Participant Conduct Agreement Form

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The University of Michigan requests this information so that the Camp staff can properly plan to meet the needs of each participant and, in case of emergency, that we have accurate information to provide and/or seek appropriate treatment for Participant. You are responsible for providing accurate and complete information.

Medical Insurance Company:

Policy Number: Group Number:

Camp Explorations Medical Authorization Form

Age: Birthdate: Height: Weight: Gender: Male Female

MEDICAL INSURANCE INFORMATION (optional)

To the best of my knowledge, my child/participant is capable of participating safely in the Camp and that any activity restrictions, allergies, medications are listed on the medical information form. As a participant, parent or guardian I understand and acknowledge that my failure to disclose relevant information may result in harm to Participant and/or others during this Camp. By signing my name I represent and warrant that I have provided all materials and important information to the University of Michigan pertaining to Participant’s medical, mental and physical condition and that it is accurate and complete. I agree to notify the University of Michigan of any changes in my child’s mental, physical or medical condition before Camp begins.

I give permission to Camp staff to provide routine first aid care and in the event of serious illness or injury, I give Camp staff permission to seek and authorize emergency medical treatment. I hold harmless and agree to indemnify the Camp and the University of Michigan from any claims, causes of action, damages and/or liabilities arising out of or resulting from said medical treatment. I further agree to accept full responsibility for any and all expenses, including medical expenses, that may derive from any injuries to my child that may occur during his/her participation in this Camp.

By revealing or disclosing the above medical information it will not be used by University personnel or employess to determine Participant’s ability to participate safely in activities. I understand that, if Participant chooses to participate in activites he/she do so voluntarily and of his/her own accord and the final decision regarding participation is solely the responsibility of myself and Participant.

List two individuals who may be contacted in case of emergency involving your child. Each person listed should be reachable by telephone and able to make decisions on behalf of your child if a parent and legal guardian cannot be reached. If necessary, an emergency contact should be able to come to the Camp site and pick up your child.

EMERGENCY CONTACT INFORMATION

Emergency Contact #1 Name:

Home Phone #: Work Phone #:

Cell Phone #: Relation:

Emergency Contact #2 Name:

Home Phone #: Work Phone #:

Cell Phone #: Relation:

Participant Name:

Parent/Guardian Name:

Parent/Guardian Signature: Date:

AUTHORIZATION FOR MEDICAL CARE

The University of Michigan does not offer any form of health, liability or other types of insurance for the participant while participating in the Camp. If you have insurance, please provide the following information to be used only in the event that medical care for your child is neeeded.

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Camp Explorations Medical Information

MEDICAL INFORMATION

For the following, please provide response and explain as appropriate:

Participant Name:

Does the participant have any limiting medical conditions that you or your doctor feel may limit Camp participation?

If yes, identify and explain.

Does the participant have a history of allergies or reactions to medications, foods, insect stings or plants? If yes, identify and explain. (Please note whether the allergy is ingested or a contact allergy).

Does the participant carry an Epi-Pen for their allergies? Yes No If yes, please include a copy of the participant’s Allergy Action Plan.

Is there any additional information that will help make this a successful camp experience for the participant?

If Participant has any other medical condition or special needs that you think is important for the Camp staff to know about, please include that information here.

Is the participant have a history of, or currently suffer from, medical condition(s) about which we need to be aware?

If yes, identify and explain.

Is the participant currently taking medication that may interfere with ability to safely participate in Camp?

If yes, identify and explain.

Is the participant taking medication that must be administered during Camp? If yes, identify and explain.

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