SCAN AND EMAIL YOUR COMPLETED FORMS TO SALES@MODS.NET OR FAX TO 954.467.0456. ALL CAMP SALES ARE FINAL. NO REFUNDS WILL BE ISSUED. MEMBERSHIP INFORMATION q I am not a MODS Member q I am currently a MODS Member (ID#____________ Exp. ___/___/___) q I would like to become a Museum member: ___ Starfish (2 people) $95 ___ Manatee (2 adults, 4 children) $135 ___ Sea Turtle (2 adults, 6 children) $235 ___ Angelfish (4 adults, 6 children) $335 PARENT INFORMATION Name ____________________________________________________________________________________________ Address __________________________________________________________________________________________ City______________________________________________________State_____________Zip______________________ Cell Phone _______________________________________ Home Phone _____________________________________ Work Phone ______________________________________ Email (required) __________________________________ CHILD INFORMATION (please photocopy form to register additional children) Child’s Name ___________________________________ Gender ________ Age _______ Date of Birth ___/___/___ GRADE Campers are assigned to groups according to incoming grade. q 1st/2nd q 3rd/4th q 5th/6th LUNCH q Check if you’re ordering lunch for your child. Complete and attach the lunch order form. CAMP T-SHIRT Mandatory camp t-shirts must be worn daily. One free t-shirt will be provided. Select size: q SM q MD q LG SUMMER CAMP ADVENTURES 2019 CAMP FEES BEFORE CARE 8–9am AFTERCARE 5–6pm LUNCH TOTAL Dates Camp Theme MODS Member Non-Member June 5–7 Superpower Dogs q $150 q $175 q $15 q $24 $ June 10–14 Hall of Heroes q $200 q $225 q $25 q $40 $ June 17–21 Zombie Survival Training q $200 q $225 q $25 q $40 $ June 24–28 Game On! q $200 q $225 q $25 q $40 $ July 1–5 Fizz, Bang, Boom! q $200 q $225 q $25 q $40 $ July 8–12 Food-ology q $200 q $225 q $25 q $40 $ July 15–19 To the Moon and Back q $200 q $225 q $25 q $40 $ July 22–26 Full STEAM Ahead q $200 q $225 q $25 q $40 $ July 29–Aug. 2 Expedition Florida q $200 q $225 q $25 q $40 $ Aug. 5–9 Hogwarts Summer School q $200 q $225 q $25 q $40 $ Aug. 12–13 Keeping it Cool q $80 q $90 q $10 q $16 $ Additional camp t-shirts are $10 each QTY: $ CAMP FEES GRAND TOTAL $ PAYMENT INFORMATION q Personal check. Accepted from Museum members only. Make checks payable to Museum of Discovery and Science. q Credit Card # __________________________________________________ CVV# ______________ Exp. Date ___/___/___ Name as it appears on credit card _________________________________________________________________ TOTAL FEES $ SIGNATURE ______________________________________________________ MODS TAX ID# FEI 59-1709542 3/2019 REGISTRATION FORM THIS FORM MUST BE COMPLETED AND SUBMITTED FOR EACH CHILD ENROLLING IN CAMP.