Build a Mini Bakery – Session 2 Registration Thank you for your interest in our Summer Mini Bakery Camp! Please fill out this registration form to help us prepare for a safe, fun, and engaging experience for your child. Make sure to complete all required sections. Student InformationStudent's Full Name:(Required) First Last Date of Birth:(Required) MM slash DD slash YYYY Age at Time of Camp:(Required)Grade Level (Ages 7–14):(Required)2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th GradeSchool:(Required)Parent / Guardian InformationPrimary Parent/Guardian Name:(Required) First Last Relationship to Student:(Required)Phone Number:(Required)Email Address:(Required) Secondary/Emergency Contact Name:(Required) First Last Emergency Contact Phone:(Required)Staff will contact only in non-life-threatening situations.Authorized Pick-UpIf different from parent/guardian.Full Name: First Last Medical InformationThis information helps us ensure your student’s safety and comfort during camp. All details are kept confidential and shared only with camp staff as needed.Allergies (food, environmental, other):Please list all allergies and describe reactions (e.g., peanuts – anaphylaxis, seasonal pollen – mild).Medical Conditions / Special Needs:Include any conditions, diagnoses, or considerations we should be aware of (e.g., asthma, ADHD, anxiety, sensory needs).Medications (Emergency Use Only):Camp staff do not administer routine medications. We can support emergency or lifesaving medications only, such as inhalers or EpiPens. If your student requires an emergency medication during camp hours, please provide the details below: Medication Name: Dosage: When/Why Administered: Does your student self-carry?Dietary Restrictions:Please note dietary needs or restrictions (e.g., vegetarian, gluten-free, religious restrictions).Emergency Medical Authorization(Required)I understand that emergency services will be contacted when staff determine it is necessary for my student’s safety. I understand. Photo & Media ReleasePlease let us know if your student can be photographed or recorded during camp activities.(Required) I give permission for my student to be photographed or recorded during camp activities for promotional or educational use. I do NOT give permission. Liability & Participation AgreementConsent(Required)I acknowledge that participation in camp activities involves some risk. I release and hold harmless the camp organizers, staff, and affiliates from liability except in cases of gross negligence. I agree to the liability and participation agreement.Date(Required) MM slash DD slash YYYY Name(Required) First Last How Did You Hear About Our Camp?This helps us improve how we reach families like yours!(Required) Museum Website Social Media (Facebook, Instagram, etc.) Email Newsletter Friend / Family Referral Print (Bear Essentials, etc.) Payment InformationPayment is collected separately, and your student’s spot is not confirmed until payment is received. Please complete payment here: Pay NowSubmission of this form does not guarantee enrollment.Your student’s spot will be confirmed once payment is received. Please feel free to contact Michael Shea Muscarello at michaelm@theminitimemachine.org.
