2018 Summer Science STEAM Camp
at Rockdale Magnet School for Science and Technology
June 4-8, 2018
Two Sessions Each Day: 9am-12pm & 12:30pm-3:30pm

For Rising 5th- 8th Grade Students
Classes and content will be split by grade level
Weekly Registration Fee: $100 per student for 1/2 day or $180 per student for 9am-3:30pm

Registration available at magnet.rockdaleschools.org 
and due May 11th
Explorations include: Forensic Science, Cupcake Engineering, Chemistry of Tie Dye, Wildlife Studies, Invention & Entrepreneurship

Registration for 2018 Summer STEAM Camp June 4- 8, 2018

PLEASE PRINT CLEARLY

Student Name: ________________________________________________________________________________

School Name (2017-2018 school year): ________________ ___________ Grade (2017-2018 school year)______

SELECT CAMP OPTION:
o	June 4 -8h All Day (9am-3:30pm: $180)

o	June 4-8th Morning Only (9am-12pm: $100)

o	June 4-8th Afternoon Only (12:30-3:30pm: $100)

Total Amount Due:	(minimum of $100 for 1 session only and max of $180 for all day)

T Shirt Type: (circle one)  Youth OR Adult	T shirt Size: (circle one)  S    M     L     XL    XXL

Forms and payment (cash, money order, or check made out to Rockdale Magnet Fund) should be mailed or delivered to Rockdale Magnet School at 930 Rowland Road, Conyers, GA 30012 by May 11, 2018.

Parent/Guardian Name(s): _______________________________________________________________ Mailing Address: ______________________________________________City___________ Zip______ Email Address: 	___________________________
Daytime Phone: ___________________________	Home Phone: ______________________________

Emergency Contact Name: 	_______  Phone: ____________________

PARENT/GUARDIAN: Please initial beside each condition below and then sign at the bottom of the form.

 	  I understand that all camp forms and the fee must be postmarked by May 11, 2018 for my student to be eligible.

 	  I understand that the camp fee is non-refundable, and I have attached a check or money order made payable to Rockdale Magnet Fund, Inc.

 	  I understand that any violation of the RCPS Behavior Code may result in dismissal from the camp without refund.

 	  I understand that transportation will not be provided for the camp.

 	  I understand that my child will be ineligible for remaining camp days without refund of camp fee if he/she is not picked up by 12 noon (for morning only) or 3:30pm (for afternoon or all day participants).

 	  I understand that my child will be supervised by students, teachers, and/or staff of Rockdale Magnet School

Parent/Guardian Signature	Date

2018 Summer STEAM Camp

Medical History, Permission and Release Form

Student Name_________________________________________________________________ Age ___________ Address_____________________________________________________ City________________ Zip__________ In case of an emergency, notify: 			___________________________________ Phone___________________ Family Physician: _____________________________________________________ Phone___________________ Family Insurance Company______________________________________________ Policy#__________________ Insurance Company Address 		_____________________________________________________________ IMMUNIZATIONS: 	Tetanus				Polio Booster		Measles		Mumps

MEDICAL HISTORY

____Asthma	____ Sinusitis	____ Bronchitis	____ Kidney	____ Heart	____ Diabetes
____Dizziness	____ Stomach Upset	____ Hay Fever	____ Other __________________________
ALLERGIES: __________________________Food (name) ____________________Medication (name)
____Poison Sumac, Oak or Ivy ____ Insect bites/stings Other ________________________________ Previous operations or serious illnesses _____________________________________________________ Any current medications _______________________________Special Diet (name)_________________

Childhood Diseases:

____Chicken Pox

___Measles

___Mumps

____Whooping Cough

Any medical needs of which adult supervisors should be aware: _________________________________
_____________________________________________________________________________________

PARENT/GUARDIAN:
My permission is granted for school supervisors to obtain necessary medical attention in case of sickness or injury of my student. I release and waive, and further agree to indemnify, hold harmless or reimburse the Rockdale County School District, the Board of Education, its successors and assigns, its members, agents, employees, and representative thereof, as well as trip supervisors, from and against any claim which I, any other parent or guardian, any sibling, the student, or any other person, firm or corporation may have or claim to have , known or unknown, directly or indirectly, from any losses, damages or injuries arising out of, during or in connection with the student’s participation in the camp the rendering of emergency medical procedures or treatment, if any.

_______________________________________________	___________________
Parent/Guardian Signature	Date