Student InformationStudent Name* First Last Student GradeParent/Guardian Name* First Last Are you a Member of the Museum & Aquarium?* Yes No Museum & Aquarium members receive discounted rates on camps and educational programs. To learn more about becoming a member, Click here.Email* **In the event of inclement weather, participants will be notified by email or phone**Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone*Alternate/Cell PhoneMedical InformationEmergency Contact Name First Last Relationship to StudentHome PhoneAlternate/Cell PhoneDoes the student have any medical conditions or allergies?* Yes No If you answered yes, please list conditions/allergies below along with any medications.Preferred Physician/HospitalInsurance/Policy #The National Mississippi River Museum & Aquarium/Dubuque County Historical Society (NMRMA/DCHS) has my authorization to obtain necessary medical treatment in the case of any emergency situation that may arise and neither I nor the indicated emergency contact is able to be reached at the time of such emergency. I agree that in no event will the NMRMA/DCHS be held liable for any injuries, accidents or losses suffered by my child/the participant while participating in any supervised programs and the NMRMA/DCHS is hereby released from liability. In addition, my signature authorizes the NMRMA/DCHS to photograph the registered participant for the reasonable use and purpose of promotional advertising for summer camps and other educational classes.* I have read the above statement and agree. Today's Date Program InformationMy student would like to attend the following programs: SCHOOL'S OUT ED-VENTURES Pricing: Member Half Day $20/Member Full Day $35 | Non-member Half Day $25/Non-member Full Day $40 Friday, April 14 Morning Session - I Toad You So Friday, April 14 Afternoon Session - Kid-izen Science SPRING BREAK DAY CAMP Pricing: Member 1 session - $20 | 2 sessions - $35 | 3 sessions - $50 | 4 sessions - $65 | 5 sessions – $80 | 6 sessions – $95 | 7 sessions – $110 | 8 sessions – $125 | 9 sessions - $140 | 10 sessions - $155 | Non – member 1 session - $30 | 2 sessions – $45 | 3 sessions – $60 | 4 sessions – $75 | 5 sessions – $90 | 6 sessions – $105 | 7 sessions - $120 | 8 sessions - $135 | 9 sessions - $150 | 10 sessions - $165 | (3RD – 5TH GRADE ONLY! K-2ND GRADE FULL) Monday, March 13 Morning Session - Get Set to Be a Vet (3RD – 5TH GRADE ONLY! K-2ND GRADE FULL) Monday, March 13 Afternoon Session - Jungle Jam (3RD – 5TH GRADE ONLY! K-2ND GRADE FULL) Tuesday, March 14 Morning Session - Chaotic Climate (3RD – 5TH GRADE ONLY! K-2ND GRADE FULL) Tuesday, March 14 Afternoon Session - Watt's That You Say? (3RD – 5TH GRADE ONLY! K-2ND GRADE FULL) Wednesday, March 15 Morning Session - Science of Soil (3RD – 5TH GRADE ONLY! K-2ND GRADE FULL) Wednesday, March 15 Afternoon Session - Roots, Shoots, Flowers, & Fruits (3RD – 5TH GRADE ONLY! K-2ND GRADE FULL) Thursday, March 16 Morning Session -3, 2, 1, Liftoff! (3RD – 5TH GRADE ONLY! K-2ND GRADE FULL) Thursday, March 16 Afternoon Session - Scientific Adventures (3RD – 5TH GRADE ONLY! K-2ND GRADE FULL) Friday, March 17 Morning Session - Team Time! (3RD – 5TH GRADE ONLY! K-2ND GRADE FULL) Friday, March 17 Afternoon Session - Candy-ology Payment Information Payment must be received to complete registration. Checks can be made payable to "NMRMA". Checks can be mailed to or dropped off in person at: National Mississippi River Museum & Aquarium Attn: Melissa Wersinger 350 E. 3rd St. Dubuque, IA 52001 To pay by credit card, please call 563-557-9545 ext. 213.