MiaSci MiniCamps Online Registration

Please submit separate registrations for each child:
*Required Fields

Grades: Pre-K thru 5th

Cost: $45 for Members / $55 for Non-members

Time: 9:00 am to 3:30 pm

Classes:

	Member	Non-Member
Thursday, September 29, 2011 - Cosmic Explorers	$45	$55
Friday, October 28, 201 - Wizard Science	$45	$55
Monday, January 23, 2012 - Eco Investigations	$45	$55
Friday, February 3, 2012 - Engineer It	$45	$55
Friday, March 30, 2012 - Extreme Green	$45	$55

Before Care	$5	$5
After Care	$12	$12

Registration Information

*Required Fields

Child's Name:
Age:
Birth Date:
School:
Grade:
Parent Name(s):
Email Address:
Address:
City:
State:
Zip:
Home Number:
Work Number:
Emergency Contact Name:
Emergency Contact Number:

Payment Information

*Required Fields

Credit Card Type:
Credit Card #:
Expiration Date:
Name on Credit Card:

Authorization

I authorize the Miami Science Museum to take my child to Mercy Hospital in the event of an emergency. I, for myself, my spouse, my child/children and heirs, release and hold harmless the Miami Science Museum, Inc. and its officers, employees and related parties from any and all liability, actions and causes of actions of any kind arising as a consequence of the attendance of, or participation by, my child/children in any program, class or other function of the Museum, whether on-site, off-site or in transit. I understand that photographs may be taken for marketing purposes and give my permission for pictures of my child to be used.

Yes No