Form
Student Information
Guardian Information (1)
Guardian Information (2)
Medical & Food Information
Student
Additional Comments
My Products
*
Astro Pioneers (Rocketry Only)
March 18
Astro Pioneers (Robotics Only)
March 19
Orbital Engineers (Robotics Only)
March 20
Orbital Engineers/Mission Robotics (Full Camp)
March 23-26 (4 days)
Total
My Products
*
Astro Pioneers (Rocketry Only)
March 18
Astro Pioneers (Robotics Only)
March 19
Orbital Engineers (Robotics Only)
March 20
Orbital Engineers/Mission Robotics (Full Camp)
March 23-26 (4 days)
Total
Name
*
First Name
Last Name
Grade Level
*
School District
*
Guardian's Full Name
*
First Name
Last Name
Relationship to Student
*
Primary Phone Number
*
Please enter a valid phone number.
Alternative phone number
*
Please enter a valid phone number.
*
example@example.com
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Guardian's Full Name
*
First Name
Last Name
Relationship to Student
*
Primary Phone Number
*
Please enter a valid phone number.
Alternative phone number
*
Please enter a valid phone number.
*
example@example.com
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Does the student have any food allergies or dietary restrictions?
*
Yes
No
If "Yes", please specify
Does the student have any medical conditions or special accommodations needed?
*
Yes
No
If "Yes", please provide detail
Does the student have any food allergies or dietary restrictions?
*
Yes
No
If "Yes", please specify
Permissions & Waivers
*
I consent to photos/videos of my child being used for promotional purposes
I authorize the camp staff to secure emergency medical care for my child if necessary
I agree to the camp's terms and conditions
How did you hear about us?
*
Any other information we should know?
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Form
Astro Pioneers (Rocketry Only)
March 18
$
99.00
Astro Pioneers (Robotics Only)
March 19
$
99.00
Orbital Engineers (Robotics Only)
March 20
$
99.00
Orbital Engineers/Mission Robotics (Full Camp)
March 23-26 (4 days)
$
369.00
Total
$
0.00
Student Information
Name
*
First Name
Last Name
Grade Level
*
School District
*
Guardian Information (1)
Guardian's Full Name
*
First Name
Last Name
Relationship to Student
*
Primary Phone Number
*
Please enter a valid phone number.
Alternative phone number
*
Please enter a valid phone number.
*
example@example.com
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Guardian Information (2)
Guardian's Full Name
*
First Name
Last Name
Relationship to Student
*
Primary Phone Number
*
Please enter a valid phone number.
Alternative phone number
*
Please enter a valid phone number.
*
example@example.com
Medical & Food Information
Student
Does the student have any food allergies or
dietary restrictions?
*
Yes
No
If "Yes", please specify
Does the student have any medical conditions or special accommodations needed?
*
Yes
No
If "Yes", please provide detail
Does the student have any food allergies or
dietary restrictions?
*
Yes
No
If "Yes", please specify
Permissions & Waivers
*
I consent to photos/videos of my child being
used for promotional purposes
I authorize the camp staff to secure
emergency medical care for my child if
necessary
I agree to the camp's terms and conditions
Additional Comments
How did you hear about us?
*
Any other information we should know?
Payment Methods
Choose from one of the PayPal options to make your payment.
Checkout
Pay Later
Buy now, pay later. Learn more
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of stargazers, explorers, and cosmic enthusiasts as we embark on a journey through the cosmos like never before.
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Space Trek @ Atlantis Educational Services, Mail Code AES, Building M6-306 State Highway 405 Kennedy Space Center, FL 32899 United States of America
Education
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