Spring Break Camp Registration | A Time For Science

About You

Parent/Guardian Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

How Can We Reach You?

We look forward to staying connected with you before and during the camps to keep you informed and engaged every step of the way.

Preferred Method of Contact

Your Email Address(Required)

Email Address Confirm Email Address

Home/Cell Phone(Required)

Work Phone(Required)

About Your Camper

Here’s where we’ll gather a bit of information about your camper so we can give them the best care and make their camp experience amazing!

Camper Name(Required)

First Last

Date of Birth(Required)

Grade Level for current School Year(Required)

Pronouns

Camp Selection

Choose the camps your camper is excited to attend! Each camp is just $200!
For any inquiries, refer to the FAQ or reach out to Sam Eubanks at sam.eubanks@naturalsciences.org..

Full Day Camps(Required)

Spring Break Camp: March 16-20

Total

Spring Break Camp

Spring Break Camp at NCMNS Contentnea Creek: March 16-20

Price:

Media Authorization

I authorize ATFS to photograph and/or record video of my child for educational and promotional purposes.

Yes

No

Please list any health conditions or allergies your child has.

Does your child take any medications?(Required)

Yes

No

If yes, please list any medications(Required)

Please specify any ADA accommodations your child requires:

Would you like to register second camper?

Yes

No

About Your Second Camper

Here’s where we’ll gather a bit of information about your camper so we can give them the best care and make their camp experience amazing!

Camper Name: 2(Required)

First Last

Date of Birth(Required)

Grade Level for current school year(Required)

Pronouns

Camp Selection for Second Camper

Choose the camps your second camper is excited to attend! Each camp is just $200!
For any inquiries, refer to the FAQ or reach out to Sam Eubanks at sam.eubanks@naturalsciences.org.

Full Day Camps(Required)

Spring Break Camp: March 16-20

Total

Spring Break Camp

Spring Break Camp at NCMNS Contentnea Creek: March 16-20

Price:

Media Authorization(Required)

I authorize ATFS to photograph and/or record video of my child for educational and promotional purposes.

Yes

No

Please list any health conditions or allergies your child has.

Does your child take any medications?(Required)

Yes

No

If yes, please list any medications(Required)

Please specify any ADA accommodations your child requires:

Would you like to register third camper?

Yes

No

About Your Third Camper

Here’s where we’ll gather a bit of information about your camper so we can give them the best care and make their camp experience amazing!

Camper Name: 3(Required)

First Last

Date of Birth(Required)

Grade Level for Current School Year(Required)

Pronouns

Camp Selection for Third Camper

Choose the camps your third camper is excited to attend! Each camp is just $200!
For any inquiries, refer to the FAQ or reach out to Sam Eubanks at sam.eubanks@naturalsciences.org.

Full Day Camps(Required)

Spring Break Camp: March 16-20

Total

Spring Break Camp

Spring Break Camp at NCMNS Contentnea Creek: March 16-20

Price:

Media Authorization(Required)

I authorize ATFS to photograph and/or record video of my child for educational and promotional purposes.

Yes

No

Please list any health conditions or allergies your child has.

Does your child take any medications?(Required)

Yes

No

If yes, please list any medications(Required)

Please specify any ADA accommodations your child requires:

Would you like to register fourth camper?

Yes

No

About Your Fourth Camper

Here’s where we’ll gather a bit of information about your camper so we can give them the best care and make their camp experience amazing!

Camper Name: 4(Required)

First Last

Date of Birth(Required)

Grade Level for Current School Year(Required)

Pronouns

Camp Selection Fourth Camper

Choose the camps your fourth camper is excited to attend! Each camp is just $200!
For any inquiries, refer to the FAQ or reach out to Sam Eubanks at sam.eubanks@naturalsciences.org.

Full Day Camps(Required)

Spring Break Camp: March 16-20

Total

Spring Break Camp

Spring Break Camp at NCMNS Contentnea Creek: March 16-20

Price:

Media Authorization(Required)

I authorize ATFS to photograph and/or record video of my child for educational and promotional purposes.

Yes

No

Please list any health conditions or allergies your child has.

Does your child take any medications?(Required)

Yes

No

If yes, please list any medications(Required)

Please specify any ADA accommodations your child requires:

Authorized Pick-Up Persons

List all people who are authorized to pick up your child.

Emergency Contact Information

Name(Required)

First Last

Phone(Required)

Relationship to Child/Children(Required)

Emergency Medical Consent(Required)

I grant permission for emergency medical treatment to be provided to my child/children if necessary, in the event of a medical emergency where I cannot be contacted right away.

Medical Provider(Required)

Phone(Required)

Insurance Carrier(Required)

Insurance Policy Number(Required)

Insurance Policy Number: Camper 2(Required)

Insurance Policy Number: Camper 3(Required)

Insurance Policy Number: Camper 4(Required)

Who is financially responsible for the Child/Children(Required)

First Last

Payment & Agreements

Total

Coupon

Credit Card(Required)

CAPTCHA

Spring Break Camp Online Registration Form

Use this form to register and secure your child’s spot in our Spring Break Camp. Spring Break Camnp is a full day science camp that runs from March 16-20 from 7:15am – 5:45 pm. Payment will be conveniently completed during the registration process.

About You

How Can We Reach You?

About Your Camper

Camp Selection

About Your Second Camper

Camp Selection for Second Camper

About Your Third Camper

Camp Selection for Third Camper

About Your Fourth Camper

Camp Selection Fourth Camper

Authorized Pick-Up Persons

Emergency Contact Information

Payment & Agreements