Conwell Egan High School

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RECEIPT

Conwell-Egan Catholic High School

STEM Rocket Camp

Join us at CEC’s STEM Rocket Academy! Our camp focuses around designing, building, and launching compressed air and chemical rockets which will provide fun, hands-on activities that cover a wide range of scientific and engineering principles, culminating with an altitude and accuracy competition.

Date: July 14th - July 18th
Time: 9:00am - 12:00pm
Cost: $150 per camper
Grades 6-8 are welcome

Areas of focus;

Potential and Kinetic Energy
Aerodynamics and Flight Dynamics
Newton’s Law of Motion
Pneumatic Systems
Projectile Motion
Strength Materials
And much more!

Payment Options

Qty

Description

Amount

Total

STEM Rocket Camp

$150.00

Cost is per child

Discount Code

---

Total: $150.00

Student Information

Child's Name: *

Grade in Sept. 2025: *

Current School: *

T-Shirt Size: *

Operations or serious injuries:

(dates)

Chronic or recurring illness(es):

Dietary Restrictions:

Current Medications:

Allergies

(Please note whether the allergy is an ingested or a contact allergy)

Does your child carry an Epi-Pen?

If yes, for what allergy:

Comments:

PHOTO RELEASE
I grant permission for my child to be photographed, filmed, videotaped or otherwise recorded and for my child’s likeness, image, appearance, and/or voice to be used in Camp materials, productions made by or on behalf of Conwell-Egan, or in advertising or trade in promoting and publicizing the Camp, Conwell-Egan, or its or their operation, affiliates, and business partners.

Photo/Video Release: *

SURVEY RELEASE
I grant permission for my child to participate in short surveys about their perspectives on science and satisfaction with camp. There is no risk to your child.

Survey Release: *

Parent Contact Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

A receipt will be e-mailed to this address.

Alternative Departure

Please list anyone who will pick up your child. Only listed adults will be allowed to pick up. All adults authorized for release must present a photo ID at pick up. I grant permission for my child to leave with the following adult guardians in addition to those listed above.

Alternate Name:

Alternate Phone:

Liability Release

I/We being the parents(s) or legal guardian(s) for, above named child(ren) hereby give Conwell-Egan Catholic High School (CEC) staff permission to administer basic first aid when applicable, including the treatment of minor cuts, scrapes, burns (including sunburns) and stings. Medication will not be administered by CEC staff at any time. I hereby give permission to medical personnel and Emergency Medical Services selected by the staff of CEC to provide transportation and treatments, including X-rays and routine tests, for my child. In the event that I cannot be reached in an emergency, I hereby give permission to the physician/hospital where my child is transported to secure and administer treatment, including hospitalization and surgery, for my child. The completed forms may be photocopied for trips out of camp. I agree to assume financial responsibility for all medical and hospital expenses.

On behalf of the child/minor, I hereby release, discharge and hold harmless, Conwell-Egan Catholic High School, and their employees from and against all losses, claims, actions, costs, expenses and or damages, including attorney fees, arising out of my/our child’s participation in the STEM Rocket Academy Camp, except for the willful misconduct or gross negligence of Conwell-Egan.

I/We have carefully read this release prior to it’s execution and I/We fully understand its contents.

Parent/Guardian Signature: *

Relationship to the child(ren): *

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *