Summer Camp Registration Form

Welcome to the Science East Summer Camps 2015 registration form. Please note that while your registration may be submitted, your spot in camp will NOT be guaranteed until payment is processed. Please call or visit Science East to process payment once your form is submitted.

Child's information

Child's last name (required)

Child's first name (required)

Child's sex

Child's date of birth (required)
[date* bdate date-format:dd/mm/yy year-range:1900-2100 first-day:0 change-month change-year buttons placeholder "dd/mm/yyyy"]

Allergies or other medical or behavioral concerns (required - leave as N/A if none)


Street address (required)

City (required)

Province/Territory? (required)

Postal code (required)

Parent/Guardian information

First parent's/guardian's name (required)

Second parent's/guardian's name(s) (optional)

Contact e-mail (required)

10 digit emergency contact #(required)

10 digit home #(optional)

10 digit Cell #(optional)

Camp information

Name of the camp you wish your child to attend? (required)
If the camp you are interested in is not in the list, space may be limited. Please call 457-2340 to register.
Payment NOT required for waiting lists.

Please confirm the dates you wish your child to attend (required)
[date* date-start date-format:dd/mm/yy min-date:22/06/2015 max-date:17/08/2015 first-day:0 change-month buttons no-weekends placeholder "dd/mm/yyyy"] until [date* date-end date-format:dd/mm/yy min-date:26/06/2015 max-date:21/08/2015 first-day:0 change-month buttons no-weekends placeholder "dd/mm/yyyy"]

During camps, we may take photos of your child for publicity purposes. Please check one of the following boxes.
 allow deny

Membership information

Are you a Science East member? (required)
 yes no

Would you like to receive e-mails about upcoming events and programs?
 yes no

Full payment is due upon registration. Cost of camp includes a non refundable $50 deposit. We regret that we are unable to refund fees with less than 5 business days notice of cancellation.
Science East reserves the right to cancel any program or activity not meeting the minimum registration requirements, If cancellation is necessary, you will be contacted at least 48 hours in advance and your fees will be refunded in full.