You may register up to FOUR campers per form. For questions regarding registration or payment, please contact Amanda Bakay at email@example.com. For questions regarding camp content and curriculum, please contact Angel Kilyan at firstname.lastname@example.org. Parent/Guardian Name* First Last Parent/Guardian Email*Please use the email address at which you would like to receive updates and reminders about you camp(s). Parent/Guardian Phone*Please use the phone number at which you can be reached during camp(s). Address* Street Address PO Box or Apt City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Camper InformationCamper 1 Name* First Last Camper 1 Grade*KindergartenFirstSecondThirdFourthFifthSixthSeventhEighthAdd Another Camper?* Yes No Camper 2 Name First Last Camper 2 GradeKindergartenFirstSecondThirdFourthFifthSixthSeventhEighthAdd Another Camper? Yes No Camper 3 Name First Last Camper 3 GradeKindergartenFirstSecondThirdFourthFifthSixthSeventhEighthAdd Another Camper? Yes No Camper 4 Name First Last Camper 4 GradeKindergartenFirstSecondThirdFourthFifthSixthSeventhEighthChild Safety and Parental ConsentParental Release Statement*By checking this box I have read and agree to the terms of the Lancaster Science Factory Parental Release Statement: Lancaster Science Factory Camp/Program Parental Release Agreement: I hereby grant permission for my child to participate in the enrolled camp or program at the Lancaster Science Factory as described. I understand the Lancaster Science Factory may deny enrollment or dismiss at any time any enrollee whom it considers not to be participating properly in the camp or program. I also understand that any of the camps or programs receiving an insufficient registration may be cancelled. In the event of an emergency requiring immediate medical treatment, I understand that the staff of the Lancaster Science Factory will try to reach me by using the telephone numbers listed in this form. In the event that I cannot be reached, I authorize treatment by appropriate personnel to administer any prescribed medications to my child or any emergency care (i.e. Epipen for allergic reactions) as approved by Lancaster Science Factory staff. If such care is needed, I authorize the Lancaster Science Factory to make the decision to take my child to the nearest hospital (Lancaster General Hospital) in the event of extreme emergency. We understand and accept the need for the Lancaster Science Factory to be fully informed as to the physical and mental health of the enrollee. Failure to disclose such essential information at the time of enrollment or upon the request of the Lancaster Science Factory can be cause for dismissal from camp or program. The Lancaster Science Factory pledges to respect the confidentiality of such information and to use it only for professional purposes. Release Statement: In consideration of the acceptance of the minor for enrollment in the Lancaster Science Factory camp or program, I hereby release and discharge the Lancaster Science Factory, its agents, employees and officers from claims, demands, actions, judgments and executions which the undersigned, as parent or guardian of the enrollee, ever had or now has, or may have, or which the undersigned’s heirs, executors, administrators, or assigns may have or claim to have against the Lancaster Science Factory, its successors or assigns, for all personal injuries, known or unknown, and injuries to property, real or personal, caused by or arising out of, the camper’s enrollment in the Lancaster Science Factory Summer camp or program. I agreePhoto Release*I will allow the Lancaster Science Factory to take photos of my child. I understand that the Lancaster Science Factory may use these photographs and recordings for promotion, marketing, training and advertising. I release and hold the Lancaster Science Factory harmless for any and all present and future claims for compensation or damages relating to this release. I consent I do not consent Mask Requirement*By checking this box I have read and agree to the terms of the Lancaster Science Factory Pandemic Response Mask Requirement: Lancaster Science Factory Camp/Program Mask Requirement In the interest of the health and safety of all staff, visitors, and volunteers, the Lancaster Science Factory is following CDC guidance to prevent the spread of COVID-19. All children over the age of two years (2) shall be required to wear a cloth mask that covers their nose and mouth while they are inside the facility. Children unable to meet this requirement for any reason may not attend in-person programs at this time. This policy will be reviewed as additional guidance becomes available or COVID-19 conditions change. I agree to this policyPlease disclose any learning, behavioral, or medical issues (including allergies) that our educators should know about your child(ren).*Child Safety - Pick Up List*Please enter the names of all adults who are authorized to pick up your child(ren) from camp. Enter one name and then click the + to add another. Photo ID is REQUIRED for pick up. Add RemoveChoose Your CampsAll camps are for grades K - 8th. Choose a morning session, afternoon session, or choose a FULL DAY and save!Monday, December 27thMonday, December 27th - FULL DAY OF CAMP*BEST VALUE* Campers will participating in both the morning and afternoon camp with a supervised lunch break in between. Packed lunch required. Price: $65.00 Quantity: Cold Chemistry - Monday, December 27th: 9am - 12pmLet's have some fun with messy Chemistry with a winter twist! Make a swirling snow globe, cause a reaction with elephant toothpaste, and more! Price: $35.00 Quantity: Robotics - Monday, December 27th : 1pm - 4pmCheck out our ever-growing robot army! Beginner programmers and more experienced coders will enjoy this immersive Maker Space camp. Price: $35.00 Quantity: Tuesday, December 28thTuesday, December 28th - FULL DAY OF CAMP*BEST VALUE* Campers will participating in both the morning and afternoon camp with a supervised lunch break in between. Packed lunch required. Price: $65.00 Quantity: Harry Potter Sweet Treats- Tuesday, December 28th: 9am - 12pmDive into the real science behind the magic of Harry Potter, with a focus on the food and drink! Measure your ingredients carefully and you might just make a charming concoction! ALLERGY WARNING: LSF educators need to know any and all food allergies for this camp. Please be sure to disclose them so appropriate substitutions can be made. Price: $35.00 Quantity: Twinkling Lights and Circuits- Tuesday, December 28th: 1pm - 4pmYou've heard the saying that if one holiday light goes out, they all go out. But do you know why? Build circuits from simple to complex using a variety of conductive material. It's Lit! Price: $35.00 Quantity: Wednesday, December 29thWednesday, December 29th - FULL DAY OF CAMP*BEST VALUE* Campers will participating in both the morning and afternoon camp with a supervised lunch break in between. Packed lunch required. Price: $65.00 Quantity: Rockin' Reindeer Art - Wednesday, December 29th: 9am - 12pmArtist and LSF Educator, Brooke, leads this art camp! Every camper gets their own canvas to make a fun reindeer design. Customize with your own colors and finishing touches! Price: $35.00 Quantity: Build a Winter Wonderland - Wednesday, December 29th: 1pm - 4pmYou're the engineer (and city planner) as you design and build your own winter village. The only limit is your imagination! Price: $35.00 Quantity: Thursday, December 30thThursday, December 30th - FULL DAY OF CAMP*BEST VALUE* Campers will participating in both the morning and afternoon camp with a supervised lunch break in between. Packed lunch required. Price: $65.00 Quantity: Costume Creations - Thursday, December 30th: 9am - 12pmThe holiday season is full of special occasions and costume characters. Learn how to plan, measure, cut, and put together your own winter-themed costume. Price: $35.00 Quantity: Toy Deconstruction Lab - Thursday, December 30th: 1pm - 4pmYou know that elves MAKE toys, but here in our Maker Space we like to take them apart! Join in the fun of one of most popular camps. Deconstruct electronic toys, see how they work, and reassemble them into a whole new creation! Price: $35.00 Quantity: Friday, December 31st (AM Camp Only)Wonderland Slime Lab - Friday, December 31st: 9am - 12pm3,2,1 HAPPY NEW YEAR! Send off 2021 slime style. Kids will make several batches of slime during this messy and fun camp! Price: $35.00 Quantity: Payment InformationMember Discount Code LSF Member Families receive 10% off all camps and programs. Total Credit Card* DiscoverMasterCardVisaSupported Credit Cards: Discover, MasterCard, Visa Card Number Month010203040506070809101112 Month Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Year Expiration Date Security Code Cardholder Name EmailThis field is for validation purposes and should be left unchanged.