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Thank you for choosing the Museum of Discovery & Science and Camp Discovery for your child's STEM camp experience. If you have any questions when completing this form, please call us at 954.713.0930 or email booking@mods.net. Our guest experience specialists will be happy to assist you.

School’s Out Camp Registration

MEMBERSHIP INFORMATION I am not a current MODS memberI am currently a MODS Member-ID#
PARENT INFORMATION
CHILD INFORMATION
CHILD 1
CAMP DISCOVERY PROGRAM SELECTIONS

One-Day Camps
Museum members: $50
Non-members: $55

Five-Day Camps
Museum members: $200
Non-members: $225

Multi child discounts: Save $25 off total for each One-Day Camp or Five-Day Camp.
Multiple day camps cannot be prorated for fewer days attended.

PLEASE MAKE YOUR SELECTION BELOW *

Chilly Chemistry and Snowflake Science - (Four-Day Camp - No camp December 25)Jedi Training Academy - December 30 – January 3 (Five-Day Camp)Back From The Brink: Conservation Crusaders - January 6 (One-Day Camp)Messy Matter - January 20 (One-Day Camp)Cupid’s Chemistry Lab - February 17 (One-Day Camp)Expedition: Dinosaurs - March 17 (One-Day Camp)Gamers - March 20 (One-Day Camp)STEAM Makerspace March 23 - 27 (Five-Day Camp)Totally Tech - April 10 (One-Day Camp)
BEFORE AND AFTERCARE

The regular camp day runs from 9 a.m. - 5 p.m. Should you need before and aftercare, which extends the camp day to 8 a.m. - 6 p.m. for an additional $5 per day, please indicate below.

Yes – My child does need before/aftercare.No – My child does not need before/aftercare


LUNCH

Please indicate your child's lunch plan (choose one):

My child will be bringing lunch from home.I would like to preorder the Museum's box lunch.

• The full sandwich lunch box costs $8.00 per day and includes a sandwich, bag of chips, cookie and a juice pouch.
• Lunch orders must be placed one week prior to the start of camp. Lunches cannot be purchased on the same day camp starts.
• By checking ONE option below. Your child will receive this selection each day of camp for the length of camp. For example, if your child is signed up for a four-day camp and turkey sandwich is selected, he/she will receive a turkey sandwich box lunch on each of the four days of camp at a cost of $8.00 per day.
• Lunch orders cannot be changed once orders have been processed.
• Sorry, no modifications can be made to the lunch options.

Please indicate your child’s lunch order by checking one of the options below.

Full double decker turkey and cheddar on white with lettuce and mayo pack.Full double decker ham and mozzarella cheese on white with lettuce and mayo packFull double decker Italian (ham and salami) with mozzarella on white bread with lettuce and mayo pack.Full veggie on white wrap with Italian dressing pack.

MEDICAL INFORMATION

Is your child taking any medications regularly?*

NoYes

If yes, please specify medication name, dose and any essential information in case of emergency.

Does your child have any allergies (food or environmental)*

NoYes

If yes, please specify allergy and any essential information in case of an emergency.

Please list any other information that you feel will help us ensure your camper has the best experience possible. This includes: medical background, personality or a disability.


I understand that Museum staff will not hold or dispense any medication for my child.
CHILD 2
CAMP DISCOVERY PROGRAM SELECTIONS

One-day camps
Museum members: $50
Non-members: $55

Five-day camps
Museum members: $200
Non-members: $225

Multi child discounts: Save $25 off total for each One-Day Camp or Five-Day Camp.
Multiple day camps cannot be prorated for fewer days attended.

PLEASE MAKE YOUR SELECTION BELOW *

Chilly Chemistry and Snowflake Science - (Four-Day Camp - No camp December 25)Jedi Training Academy - December 30 – January 3 (Five-Day Camp)Back From The Brink: Conservation Crusaders - January 6 (One-Day Camp)Messy Matter - January 20 (One-Day Camp)Cupid’s Chemistry Lab - February 17 (One-Day Camp)Expedition: Dinosaurs - March 17 (One-Day Camp)Gamers - March 20 (One-Day Camp)STEAM Makerspace March 23 - 27 (Five-Day Camp)Totally Tech - April 10 (One-Day Camp)
BEFORE AND AFTERCARE

The regular camp day runs from 9 a.m. - 5 p.m. Should you need before and aftercare, which extends the camp day to 8 a.m. - 6 p.m. for an additional $5 per day, please indicate below.

Yes – My child does need before/aftercare.No – My child does not need before/aftercare


LUNCH

Please indicate your child's lunch plan (choose one):

My child will be bringing lunch from home.I would like to preorder the Museum's box lunch.

• The full sandwich lunch box costs $8.00 per day and includes a sandwich, bag of chips, cookie and a juice pouch.
• Lunch orders must be placed one week prior to the start of camp. Lunches cannot be purchased on the same day camp starts.
• By checking ONE option below. Your child will receive this selection each day of camp for the length of camp. For example, if your child is signed up for a four-day camp and turkey sandwich is selected, he/she will receive a turkey sandwich box lunch on each of the four days of camp at a cost of $8.00 per day.
• Lunch orders cannot be changed once orders have been processed.
• Sorry, no modifications can be made to the lunch options.

Please indicate your child’s lunch order by checking one of the options below.

Full double decker turkey and cheddar on white with lettuce and mayo pack.Full double decker ham and mozzarella cheese on white with lettuce and mayo packFull double decker Italian (ham and salami) with mozzarella on white bread with lettuce and mayo pack.Full veggie on white wrap with Italian dressing pack.
MEDICAL INFORMATION

Is your child taking any medications regularly?*

NoYes

If yes, please specify medication name, dose and any essential information in case of emergency.

Does your child have any allergies (food or environmental)*

NoYes

If yes, please specify allergy and any essential information in case of an emergency.

Please list any other information that you feel will help us ensure your camper has the best experience possible. This includes: medical background, personality or a disability.

I understand that Museum staff will not hold or dispense any medication for my child.
CHILD 3
CAMP DISCOVERY PROGRAM SELECTIONS

One-day camps
Museum members: $50
Non-members: $55

Five-day camps
Museum members: $200
Non-members: $225

Multi child discounts: Save $25 off total for each One-Day Camp or Five-Day Camp.
Multiple day camps cannot be prorated for fewer days attended.

PLEASE MAKE YOUR SELECTION BELOW *

Chilly Chemistry and Snowflake Science - (Four-Day Camp - No camp December 25)Jedi Training Academy - December 30 – January 3 (Five-Day Camp)Back From The Brink: Conservation Crusaders - January 6 (One-Day Camp)Messy Matter - January 20 (One-Day Camp)Cupid’s Chemistry Lab - February 17 (One-Day Camp)Expedition: Dinosaurs - March 17 (One-Day Camp)Gamers - March 20 (One-Day Camp)STEAM Makerspace March 23 - 27 (Five-Day Camp)Totally Tech - April 10 (One-Day Camp)
BEFORE AND AFTERCARE

The regular camp day runs from 9 a.m. - 5 p.m. Should you need before and aftercare, which extends the camp day to 8 a.m. - 6 p.m. for an additional $5 per day, please indicate below.

Yes – My child does need before/aftercare.No – My child does not need before/aftercare


LUNCH

Please indicate your child's lunch plan (choose one):

My child will be bringing lunch from home.I would like to preorder the Museum's box lunch.

• The full sandwich lunch box costs $8.00 per day and includes a sandwich, bag of chips, cookie and a juice pouch.
• Lunch orders must be placed one week prior to the start of camp. Lunches cannot be purchased on the same day camp starts.
• By checking ONE option below. Your child will receive this selection each day of camp for the length of camp. For example, if your child is signed up for a four-day camp and turkey sandwich is selected, he/she will receive a turkey sandwich box lunch on each of the four days of camp at a cost of $8.00 per day.
• Lunch orders cannot be changed once orders have been processed.
• Sorry, no modifications can be made to the lunch options.

Please indicate your child’s lunch order by checking one of the options below.

Full double decker turkey and cheddar on white with lettuce and mayo pack.Full double decker ham and mozzarella cheese on white with lettuce and mayo packFull double decker Italian (ham and salami) with mozzarella on white bread with lettuce and mayo pack.Full veggie on white wrap with Italian dressing pack.
MEDICAL INFORMATION

Is your child taking any medications regularly?*

NoYes

If yes, please specify medication name, dose and any essential information in case of emergency.

Does your child have any allergies (food or environmental)*

NoYes

If yes, please specify allergy and any essential information in case of an emergency.

Please list any other information that you feel will help us ensure your camper has the best experience possible. This includes: medical background, personality or a disability.

I understand that Museum staff will not hold or dispense any medication for my child.
CHILD 4
CAMP DISCOVERY PROGRAM SELECTIONS

One-day camps
Museum members: $50
Non-members: $55

Five-day camps
Museum members: $200
Non-members: $225

Multi child discounts: Save $25 off total for each One-Day Camp or Five-Day Camp.
Multiple day camps cannot be prorated for fewer days attended.

PLEASE MAKE YOUR SELECTION BELOW *

Chilly Chemistry and Snowflake Science - (Four-Day Camp - No camp December 25)Jedi Training Academy - December 30 – January 3 (Five-Day Camp)Back From The Brink: Conservation Crusaders - January 6 (One-Day Camp)Messy Matter - January 20 (One-Day Camp)Cupid’s Chemistry Lab - February 17 (One-Day Camp)Expedition: Dinosaurs - March 17 (One-Day Camp)Gamers - March 20 (One-Day Camp)STEAM Makerspace March 23 - 27 (Five-Day Camp)Totally Tech - April 10 (One-Day Camp)
BEFORE AND AFTERCARE

The regular camp day runs from 9 a.m. - 5 p.m. Should you need before and aftercare, which extends the camp day to 8 a.m. - 6 p.m. for an additional $5 per day, please indicate below.

Yes – My child does need before/aftercare.No – My child does not need before/aftercare


LUNCH

Please indicate your child's lunch plan (choose one):

My child will be bringing lunch from home.I would like to preorder the Museum's box lunch.

• The full sandwich lunch box costs $8.00 per day and includes a sandwich, bag of chips, cookie and a juice pouch.
• Lunch orders must be placed one week prior to the start of camp. Lunches cannot be purchased on the same day camp starts.
• By checking ONE option below. Your child will receive this selection each day of camp for the length of camp. For example, if your child is signed up for a four-day camp and turkey sandwich is selected, he/she will receive a turkey sandwich box lunch on each of the four days of camp at a cost of $8.00 per day.
• Lunch orders cannot be changed once orders have been processed.
• Sorry, no modifications can be made to the lunch options.

Please indicate your child’s lunch order by checking one of the options below.

Full double decker turkey and cheddar on white with lettuce and mayo pack.Full double decker ham and mozzarella cheese on white with lettuce and mayo packFull double decker Italian (ham and salami) with mozzarella on white bread with lettuce and mayo pack.Full veggie on white wrap with Italian dressing pack.
MEDICAL INFORMATION

Is your child taking any medications regularly?*

NoYes

If yes, please specify medication name, dose and any essential information in case of emergency.

Does your child have any allergies (food or environmental)*

NoYes

If yes, please specify allergy and any essential information in case of an emergency.

Please list any other information that you feel will help us ensure your camper has the best experience possible. This includes: medical background, personality or a disability.

I understand that Museum staff will not hold or dispense any medication for my child.
CHILD 5
CAMP DISCOVERY PROGRAM SELECTIONS

One-day camps
Museum members: $50
Non-members: $55

Five-day camps
Museum members: $200
Non-members: $225

Multi child discounts: Save $25 off total for each One-Day Camp or Five-Day Camp.
Multiple day camps cannot be prorated for fewer days attended.

PLEASE MAKE YOUR SELECTION BELOW *

Chilly Chemistry and Snowflake Science - (Four-Day Camp - No camp December 25)Jedi Training Academy - December 30 – January 3 (Five-Day Camp)Back From The Brink: Conservation Crusaders - January 6 (One-Day Camp)Messy Matter - January 20 (One-Day Camp)Cupid’s Chemistry Lab - February 17 (One-Day Camp)Expedition: Dinosaurs - March 17 (One-Day Camp)Gamers - March 20 (One-Day Camp)STEAM Makerspace March 23 - 27 (Five-Day Camp)Totally Tech - April 10 (One-Day Camp)
BEFORE AND AFTERCARE

The regular camp day runs from 9 a.m. - 5 p.m. Should you need before and aftercare, which extends the camp day to 8 a.m. - 6 p.m. for an additional $5 per day, please indicate below.

Yes – My child does need before/aftercare.No – My child does not need before/aftercare


LUNCH

Please indicate your child's lunch plan (choose one):

My child will be bringing lunch from home.I would like to preorder the Museum's box lunch.

• The full sandwich lunch box costs $8.00 per day and includes a sandwich, bag of chips, cookie and a juice pouch.
• Lunch orders must be placed one week prior to the start of camp. Lunches cannot be purchased on the same day camp starts.
• By checking ONE option below. Your child will receive this selection each day of camp for the length of camp. For example, if your child is signed up for a four-day camp and turkey sandwich is selected, he/she will receive a turkey sandwich box lunch on each of the four days of camp at a cost of $8.00 per day.
• Lunch orders cannot be changed once orders have been processed.
• Sorry, no modifications can be made to the lunch options.

Please indicate your child’s lunch order by checking one of the options below.

Full double decker turkey and cheddar on white with lettuce and mayo pack.Full double decker ham and mozzarella cheese on white with lettuce and mayo packFull double decker Italian (ham and salami) with mozzarella on white bread with lettuce and mayo pack.Full veggie on white wrap with Italian dressing pack.
MEDICAL INFORMATION

Is your child taking any medications regularly?*

NoYes

If yes, please specify medication name, dose and any essential information in case of emergency.

Does your child have any allergies (food or environmental)*

NoYes

If yes, please specify allergy and any essential information in case of an emergency.

Please list any other information that you feel will help us ensure your camper has the best experience possible. This includes: medical background, personality or a disability.

I understand that Museum staff will not hold or dispense any medication for my child.

General Information

Check-In (8:30 a.m. to 9:00 a.m.)

FIRST DAY OF CAMP ONLY
Check in at Information Desk at the Museum of Discovery and Science

Each day a parent or guardian will be expected to sign in their child. You may temporarily park your car in the bus loop located on SW 5TH Avenue for drop-off and pick-up PRIOR to 4 p.m.


Check-Out (4:00 p.m. to 5:00 p.m.)

Parents checking in or picking up a child between the hours of 10:00 a.m. and 4:00 p.m. must visit the Information Desk. Each afternoon, after 4:00 p.m., check-out will be outside at the bottom of the stairwell on 4th Avenue, located on the east side of the Museum. A parent or guardian must present a photo ID sign the log for check-out. Only adults indicated on the Camp Policy and Emergency Information Form will be allowed to check out a camper. (NO EXCEPTIONS)


Before (8:00-9:00 a.m.) and After Care (5:00-6:00 p.m.)

A daily fee of $5 is charged per child for before/after care and will take place in the Discovery Center. An additional fee of $10 per child for each additional 5 minutes of care will be charged after 6:00 p.m.


Camp T-Shirt

All campers are required to wear a Camp Discovery t-shirt at a cost of $10/shirt. One free t-shirt per child will be provided for any multi-day camp. For one-day camps, t-shirts must be worn by all campers and are available for purchase during check-in.


Lunches and Snacks

Campers may bring their own bag lunches that do not require refrigeration or indicate their preference for a camper’s lunch pack listed on the previous page. A simple snack and water will be provided twice a day. Campers may also bring snacks from home, especially if they have dietary restrictions including kosher and allergies. Please do not send money for snack machines.


What to wear and what to bring

Campers should wear comfortable clothing that is suitable for indoors, outdoors and getting dirty. Shorts and t-shirts are recommended. Sneakers or closed-toe shoes are required. Children should be prepared to spend short periods of time outside and participate daily in physical activity. It is recommended that children bring insect repellent, sunblock and a reusable water bottle.


What not to bring

Cash, toys, electronics, cell phones and other valuables should not be brought to Camp. The Museum is not responsible for any personal items that are lost or stolen.


Contacting your child during Camp Discovery

If you have an emergency and need to contact your child during camp hours, please call 954.467.6637 ext. 207 for the Camp Director or 954.713.0930 to reach the guest experience department. If a parent would like a direct line to contact camp, then the Camp Director will provide it to you at the time of check-in.


Friday is Explore Store Day

Campers will have an opportunity to visit the Explore Store on Friday. If you’d like your child to visit the Store, please give them a little money to spend when you drop them off on Friday. If you select not to have them participate we will provide another activity for them.

Code of Conduct Agreement

Please read the following Code of Conduct policies aloud with your Child/ren.

To ensure that Camp Discovery is fun and exciting for everyone, there are some basic rules that must be followed to maintain a safe and healthy environment for all campers.

As a camper at the Museum of Discovery and Science, I agree that I will:

• Be mindful to my instructors, and respect their requests
• Be responsible for my own actions
• Keep my hands to myself
• Respect other people’s property
• Have fun in ways that are safe to others and myself
• Respect my fellow campers
• Use appropriate language
• Tell my instructors when I need help or if someone is bothering me

If I do not follow the rules:

First time
I will be given a verbal warning explaining the expected behavior.

Second time
I will be removed from the activity and a note will be sent home.

Third time
The camp manager will be notified, and my parents will be called to pick me up.

Eligibility:
Any child that is sent home from camp will be ineligible to return to any MODS camp for one year.

Please type your name below to indicate your acknowledgment.

Type names in the field below.


Emergency Contact Information


In case of emergency, we will contact the parents/guardians in the order listed below.

Emergency Contact 1

Emergency Contact 2

Emergency Contact 3


I authorize only the persons listed above to pick-up my child from the camp. NO EXCEPTIONS.
Please note:
In case of sudden illness or misbehavior, an adult must be immediately available to pick up the child. Museum staff may dismiss a camper at any time due to poor conduct.

EMERGENCY TREATMENT RELEASE

In the event of a serious illness, accident, or injury that would require medical attention, 911 will be called and my child may be taken to the nearest emergency center. My acknowledgment below indicates that I have read and understand the policies stated above and that I agree to abide by them.

HOLD HARMLESS

I agree to indemnify and hold harmless the Museum of Discovery and Science at 401 SW 2nd Street, Fort Lauderdale, FL 33312-1707, from any claims, damages, losses, costs and expenses resulting from the participation of my child in the Museum of Discovery and Science Camp.

PROMOTIONAL PHOTOGRAPHY RELEASE

I understand the Museum of Discovery and Science may take photos/video of students during the program for publicity purposes.

YES - You may photograph my child (for promotional purposes)NO - Do not photograph my child I would like to receive photos through the free app, Brightwheel, which can be downloaded in the Apple or Google Play stores.

My acknowledgment below indicates that I have read and understand the policies stated above and that I agree to abide by them.

Payment Information

Personal check. Accepted from Members only. Please make checks payable to Museum of Discovery and Science.Credit Card

Please note: Your credit card will be processed upon confirmation with a member of our guest experience team.