Junior Space Camp- Application/Registration

Price:$245.00

3 in stock

YES I will sign up for Junior Space Camp!

June 24th- June 28th 1pm- 5pm Monday- Friday

Registration is on a first come, first serve basis. There are 18 registration spots, 2 scholarship spots for a total of 20 spots for Junior Space camp. If registration is full please contact the museum to be added to the wait list: 608-269-0033

Student Information

Parent Information

Waiver and Release

I certify that the following child has my permission to participate in the Deke Slayton Space Camp. I hereby release the Deke Slayton Memorial Space and Bicycle Museum and their employees from any liability, claims, lawsuits, etc. from any injury or illness that may result from participation in Deke Slayton Space Camp. I certify that my child is in good physical health and can participate in all camp activities. I further certify that the above camper has medical insurance in case of an emergency. Deke Slayton Space Camp and the Deke Slayton Memorial Space and Bicycle Museum, the directors, and any staff shall not be held responsible for personal injury of any student or loss of individual property during the camp. I grant permission for the camp directors to act on my behalf in case of medical emergency. I understand that I am responsible for all medical expenses.

I (Parent’s/Guardian’s name) release the Deke Slayton Memorial Space and Bicycle Museum and Deke Slayton Space Camp from any liability, claims, lawsuits, etc. from any injury or illness my child suffer during my participation in any event organized by the Deke Slayton Memorial Space and Bicycle Museum

I (Parent’s/Guardian’s name) grant the Deke Slayton Memorial Space and Bicycle Museum, the right to take photographs of me, my child, and my family in connection with the above-identified event. I authorize the Deke Slayton Memorial Space and Bicycle Museum, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that the Deke Slayton Memorial Space and Bicycle Museum may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

Emergency Contact Information- If there is an injury or emergency who should be contacted:

Emergency Contact

Electronic Signature

I have read and fully understand the general terms and conditions as outlined in the application form and I give my child permission to participate in the Deke Slayton Space Camp, my typed name and date will be accpeted as signature and considered binding in agreeing to the terms above

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