CHILD S NAME AGE. BIRTH DATE GRADE COMPLETED AS OF 6/2016 MEMBER (check one) Yes No MOTHER MOTHER S ADDRESS STREET CITY STATE ZIP

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1 TALLAHASSEE MUSEUM JUNIOR COUNSELOR IN TRAINING REGISTRATION FORM Please use a separate form for each child. Contact ext 126 for more information. This camp training program is limited to 2 candidates per week on a first come first served basis, and is only available to campers in 6 th -8 th grade who submit all required materials. Required materials for the Junior Counselor in Training Camp 1 letter of recommendation from a teacher, coach, or community organization leader Completed application packet Full payment CHILD S NAME AGE BIRTH DATE GRADE COMPLETED AS OF 6/2016 MEMBER (check one) Yes No MOTHER MOTHER S ADDRESS STREET CITY STATE ZIP MOTHER S PHONE: HOME WORK CELL MOTHER S ADDRESS FATHER FATHER S ADDRESS STREET CITY STATE ZIP FATHER S PHONE: HOME WORK CELL FATHER S ADDRESS EMERGENCY CONTACT RELATIONSHIP PHONE: HOME WORK CELL PHYSICIAN PHONE LIST ANY MEDICAL CONDITIONS, ALLERGIES, DISABILITIES, ETC. LIST ANY MEDICATIONS YOUR CHILD IS TAKING

2 In compliance with Department of Children and Families regulations, Tallahassee Museum staff reserves the right to request the GOVERNMENT ISSUED IDENTIFICATION CARD of anyone picking up a child from camp. Child will be released only to the custodial parent(s) or legal guardian(s) & the persons listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident, or emergency if for some reason the custodial parent(s) or legal guardian(s) cannot be reached: Camp Hours: 9:00 am to 4:30 pm Extended Hours: 7:45 am to 5:45 pm Junior Counselor in Training Program: Pre K-1 st grade camps $100 for members/ $110 non-members Extended Hours for summer camp: $35/child/week CAMP DATE CAMP FEE EXTENDED CARE FEE TOTAL FEES DATE PAID CK #, CHG. OR CASH TOTAL FEES DUE $ IMPORTANT! The following section must be filled out IN FULL for us to be able to process your request. I,, hereby authorize my child,, To participate in activities sponsored by the Tallahassee Museum which may include, but are not limited to, field trips, tours, swimming and travel from the premises in Museum vehicles. In case of an accident requiring medical treatment, I authorize treatment for my child as the attending medical personnel deem appropriate. I also agree not to hold the Tallahassee Museum responsible for injuries suffered by my child during activities sponsored by it. In addition, I agree to comply with the following stipulations, and I understand that these stipulations are in the best interest of my child s safety. Government issued identification is required of persons picking up a child from camp. I have reviewed the camp rules with my child. I must sign my child in on the camp roster, and out on the camp roster each day. This requires me to accompany my child into the Museum and to the location of his/her camp group. Dropping off children at the Museum is unacceptable, and will result in termination of registration without refund. Name (Print) Parent/Guardian signature Date

3 CAMP LUNCH ORDER FORM $6.50 incl. tax (EXACT CHANGE ONLY) All lunches include one entrée, two sides, and a beverage. Camp Lunches are not available on Field Trip days. Camper s Name: Parent/Contact Name: Phone: Camp Grade (check): K-1 st Grade 2 nd -5 th Grade 6 th 8 th Grade Camp Title: Camp Days: MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 1) 1) 1) 1) 1) Hamburger PB & J Hamburger PB & J Hamburger Hotdog Cream Cheese 6 pc Chicken Nuggets Hamburger Hotdog Cream Cheese 6 pc Chicken Nuggets Hamburger Hot dog Cream Cheese SIDES (check 2) SIDES (check 2) SIDES (check 2) SIDES (check 2) SIDES (check 2) Potato Chips Potato Chips Potato Chips Potato Chips Potato Chips Fruit Cup Fruit Cup Fruit Cup Fruit Cup Fruit Cup Apple Sauce Apple Sauce Apple Sauce Apple Sauce Apple Sauce DRINK (check 1) DRINK (check 1) DRINK (check 1) DRINK (check 1) DRINK (check 1) Juice Juice Juice Juice Juice Milk Milk Milk Milk Milk Water Water Water Water Water Please make checks payable to Tallahassee Museum **If paying in cash please use EXACT change** Signature: Date: By signing above, you are approving the selection you have made. For any special accommodations, please contact the museum at cwaters@tallahasseemuseum.org

4 Dear Parent/Guardian: From time to time, the Tallahassee Museum, or the media, will take photos of our programs, which includes camps, preschool and workshops for publicity reasons. These photos are used in our newsletter and brochures, as well as local newspapers and other publications to advertise/promote the Museum and its programs. For this reason, we ask that you to sign the photo release below in order to use the photos where your child is identifiable. If you have any questions, please contact the Director of Education at ext PHOTO RELEASE I give permission for any photographs taken of my child,, during programs at the Tallahassee Museum to be used in any present or future publication or advertisement about the Tallahassee Museum. Parent/Guardian Signature Date

5 9 IMPORTANT RULES FOR CAMPERS We understand that campers are excited to come to camp. While our objective is for all campers to have a fun learning experience, we must be sure that everyone is aware of the rules that are expected of them while they are at camp. Please review these with your child prior to camp. 1. Show respect to all campers, staff, Museum guests, exhibits, wildlife, property, and the Museum itself. 2. Keep your hands, feet, head and other body parts to yourself. Fighting, hitting, theft, or destruction of property WILL NOT BE TOLERATED. 3. Appropriate language should be used at all times. 4. Cooperation and participation in group activities is expected of campers. 5. Campers must stay with our individual camp group. 6. Campers must always have a buddy when going places at the Museum or when on field trips. 7. Campers must never leave a camp group unless the teacher gives permission. 8. Campers must keep shoes ON their feet at all times. 9. Campers must follow the instructions of our camp teachers. ELECTRONIC DEVICES ****If campers bring electronic devices, they must be put away until camp teacher gives approval of their use. The Museum holds no responsibility for any items that may be lost or stolen.