MOAH Science Summer Camp Registration Form

Have MOAH Summer Fun!

Instructions: Complete this form, then print out and sign and mail with your check for registration to:
The Museum of American Heritage
P.O. Box 1731
Palo Alto, CA 94302-1731

MOAH is located at 351 Homer Avenue between Bryant and Waverley Streets.

If you wish to pay by check, your check should accompany your registration form, even if you are placed on a waiting list. If a student is on a waiting list and is not enrolled, your check will be returned to you. If you wish to pay by credit card, call 650-321-1004. Your card will not be charged until the student is enrolled.

$100 is due with your registration and the balance is due by June 13.
Camp is subject to cancellation if sufficient advance registrations are not received.

Because of the nature of the camp, any students not attending the first session of a camp will be dropped from the roster.

Waiting list

Waiting lists for summer camps are common. Students on a waiting list are encouraged to inquire a week before the camp and will be added on a space-available basis.

Camp: 
Camp Start Date: (June 20)
Fee: Member: $450
 Non-member   $500
 or Associate member:		 $
Student name: 
Address: 
City    Zip: 
Phone: area code + no. 
Emergency phone
number: Area code + no. 
How did you
hear about
this camp?: 
The following data must be supplied for all campers:
Child's age 
Child's T-shirt size
Parent/
Guardian name 
E-mail: 
School last attended by camper: 

My child has my permission to attend this camp. I hereby release the Museum of American Heritage and/or any of its agents from any liability resulting from participation in the above-mentioned activity. I understand that I am responsible for providing transportation to and from camp and off-site camp activities, that no supervision will be provided before or after camp and that I should pick up my child on time.

Parent/
Guardian Signature: 		 _________________________________________
Date: 
Parent/
Guardian Name: 
Relationship: 

This form can not be submitted online. Please print out, sign and mail.
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This page last updated: November 17, 2010