Form

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

Student Information

Name

*

First Name

Last Name

Grade Level

*

School District

*

Guardian Information

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.

Email

*

example@example.com

Billing Address

*

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Medical & Food Information

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

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?

Form

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

Student Information

Name

*

First Name

Last Name

Grade Level

*

School District

*

Guardian Information

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.

Email

*

example@example.com

Billing Address

*

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Medical & Food Information

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

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?

imagine.

imagine.

Form

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

Student Information

Name

*

First Name

Last Name

Grade Level

*

School District

*

Guardian Information

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.

Email

*

example@example.com

Billing Address

*

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Medical & Food Information

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

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?

Form

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

Student Information

Name

*

First Name

Last Name

Grade Level

*

School District

*

Guardian Information

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.

Email

*

example@example.com

Billing Address

*

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Medical & Food Information

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

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?

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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

imagine.

imagine.