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Renewable Energy STEM Camp
June 28 @ 2:00 am - June 30 @ 4:00 pm$15
STEM CAMP: Renewable Energy
SUMMER BREAK 2022 REGISTRATION FORM
Forms must be returned by Tuesday, June 21
NAME: ____________________________________________ AGE:________
CITY: ________________________STATE: ______
Students under 18: Please list below the contact name & complete mailing address:
Parent or Guardian ____________________________________________ Phone_________________
Entry Fees: $15.00 or 10.00 for members
We accept cash, checks, and money orders. You may now also pay by credit card by donating the entry amount on our website indyscitech.org. Make non-refundable checks or money orders payable to the Independence Science and Technology Center. Return entry forms to ISTC, 125 S. Penn. Ave., Independence, KS 67301. (Hours 1:00-5:00 Mon.-Sat.) Or email entry forms to email@example.com.
I give ISTC permission to take photos containing my child. Photos may be used for promotion on our website, Facebook page, or newspaper.
I hereby knowingly and voluntarily enter into this waiver and release of liability and hereby wave any and all rights, claims, or causes of action of any kind arising out of my participation in this camp.
Signature of Parent or Guardian __________________________________________