Register Now

This form will allow you to register and pay online through our website.

Group Information
Group code: (optional)

Child #1

Name of Child:
Gender:
Birthdate:
Program:
Age Group
Days/Weeks
Week 1 (June 10 - 14)
Week 2 (June 17 - 21)
Week 3 (June 24 - 28)
Week 4 (July 1 - 3) *Camp is closed on 7/4 & 7/5/13
Week 5 (July 8 - 12)
Week 6 (July 15 - 19)
Week 7 (July 22 - 26)
Week 8 (July 29 - August 2)
Week 8 (August 5 -9)
Medical conditions/allergies:
School Name and Grade:
Add another child

Child #2 (Remove)
Name of Child:
Gender:
Birthdate:
Program:
Age Group
Days/Weeks
Week 1 (June 10 - 14)
Week 2 (June 17 - 21)
Week 3 (June 24 - 28)
Week 4 (July 1 - 3) *Camp is closed on 7/4 & 7/5/13
Week 5 (July 8 - 12)
Week 6 (July 15 - 19)
Week 7 (July 22 - 26)
Week 8 (July 29 - August 2)
Week 8 (August 5 -9)
Medical conditions/allergies:
School Name and Grade:
Add another child

Child #3 (Remove)
Name of Child:
Gender:
Birthdate:
Program:
Age Group
Days/Weeks
Week 1 (June 10 - 14)
Week 2 (June 17 - 21)
Week 3 (June 24 - 28)
Week 4 (July 1 - 3) *Camp is closed on 7/4 & 7/5/13
Week 5 (July 8 - 12)
Week 6 (July 15 - 19)
Week 7 (July 22 - 26)
Week 8 (July 29 - August 2)
Week 8 (August 5 -9)
Medical conditions/allergies:
School Name and Grade:
Add another child

Child #4 (Remove)
Name of Child:
Gender:
Birthdate:
Program:
Age Group
Days/Weeks
Week 1 (June 10 - 14)
Week 2 (June 17 - 21)
Week 3 (June 24 - 28)
Week 4 (July 1 - 3) *Camp is closed on 7/4 & 7/5/13
Week 5 (July 8 - 12)
Week 6 (July 15 - 19)
Week 7 (July 22 - 26)
Week 8 (July 29 - August 2)
Week 8 (August 5 -9)
Medical conditions/allergies:
School Name and Grade:
Add another child

Child #5 (Remove)
Name of Child:
Gender:
Birthdate:
Program:
Age Group
Days/Weeks
Week 1 (June 10 - 14)
Week 2 (June 17 - 21)
Week 3 (June 24 - 28)
Week 4 (July 1 - 3) *Camp is closed on 7/4 & 7/5/13
Week 5 (July 8 - 12)
Week 6 (July 15 - 19)
Week 7 (July 22 - 26)
Week 8 (July 29 - August 2)
Week 8 (August 5 -9)
Medical conditions/allergies:
School Name and Grade:
Add another child

Child #6 (Remove)
Name of Child:
Gender:
Birthdate:
Program:
Age Group
Days/Weeks
Week 1 (June 10 - 14)
Week 2 (June 17 - 21)
Week 3 (June 24 - 28)
Week 4 (July 1 - 3) *Camp is closed on 7/4 & 7/5/13
Week 5 (July 8 - 12)
Week 6 (July 15 - 19)
Week 7 (July 22 - 26)
Week 8 (July 29 - August 2)
Week 8 (August 5 -9)
Medical conditions/allergies:
School Name and Grade:
Add another child

Child #7 (Remove)
Name of Child:
Gender:
Birthdate:
Program:
Age Group
Days/Weeks
Week 1 (June 10 - 14)
Week 2 (June 17 - 21)
Week 3 (June 24 - 28)
Week 4 (July 1 - 3) *Camp is closed on 7/4 & 7/5/13
Week 5 (July 8 - 12)
Week 6 (July 15 - 19)
Week 7 (July 22 - 26)
Week 8 (July 29 - August 2)
Week 8 (August 5 -9)
Medical conditions/allergies:
School Name and Grade:
Add another child

Parent/Guardian Information
Name of Parent(s):
Telephone (home):
Telephone (cell):
Address:
E-mail Address:
In Case of Emergency Contact:
Telephone Number:
Pediatrician:
Pediatrician Address:
Pediatrician Phone #:

By signing this form, the individual named below grants permission for their child(ren) to participate in all activities of SciTech's program including sports and games instruction to be conducted at selected locations in Manhattan, including locations in Central Park (the "Instruction"), and recognizes that there are risks of personal injury that may be associated with participation in the program and such associated activities are collectively referred to herein as the "Activities").

By his/her signature below, the parent agrees to assume all of the risks, danger and responsibilities surrounding his/her participation in the Activities. Participants hereby acknowledge and consent that images from the above activities may be used for business promotion. The individual permits SciTech to take whatever steps to obtain emergency medical care, if warranted. The individual hereby releases and discharges SciTech from any and all claims and demand of any kind for injury which the child may suffer or sustain directly or indirectly as a result of participation in SciTech's Science programs.

I agree to the above conditions and disclaimers.