Art of Science Summer Camp

Sunday, July 26, 2020 at 5:30 PM until Thursday, July 30, 2020 at 11:30 AMCentral Daylight Time

Directions

Thomas Jefferson Hall
202 W 18th St
Rolla, MO 65401
United States

Camp Registration Form

Required Field*

Student Information

Will you be staying in the residence halls for this camp or commuting from home every day?

Commuter Option (Fees include lunch, dinner and activities)

Resident Option (Fees include room and board, all meals and activities)

First Name *

Last Name *

Preferred Name (as you would like it to appear on your name badge) *

Mailing Address *

Country
Street
City
Region
Postal Code

Student Email Address *

Confirm Student Email Address *

Student Phone Number (xxx-xxx-xxxx) * (cell number while at camp)

Miscellaneous Information

Gender *

Female

Male

Birthdate *

Age of student during camp *

T-Shirt Size (adult sizes) *

School attending *

Grade level this Fall (i.e. 6th, 7th.... 11th, 12th) *

Year student will graduate from high school *

First and last name of requested roommate (not guaranteed)

Dietary Restrictions
Meals provided for summer camps will be all you can eat buffet style. If you have any medical or religious food restrictions, please list them so we can prepare.

Ethnicity

Are you of Hispanic or Latino origin?

Yes

How did you hear about this camp?

If other, please indicate how you heard about the camp.

Parent/Guardian Information

Parent/Guardian Name *

Daytime Phone (xxx-xxx-xxxx) *

Evening Phone (xxx-xxx-xxxx)

Parent/Guardian Email Address *

Confirm Parent/Guardian Email *

Pickup/Transportation Information

End of Camp Transportation Information *

Please provide the names (first/last) of all authorized persons allowed to pick you up from camp.

Please provide the name (first/last) of the authorized person you will ride home with from camp.

Art of Science Summer Camp

Missouri University of Science and Technology

#MINERSDIGDEEPER