Participant's Information

Participant's Full Legal Name *

Preferred Name

Date of birth *

Age At Start of Camp *

Current School Name *

Grade (current) *

Title 1 School (select one) *

Address

Street Address *

City *

State *

Postal Code *

Participant's Primary Language

Languages Spoken at Home

Parent/Guardian Information

Primary Parent or Guardian's Full Name *

Relationship to Participant *

Primary Email Address *

Phone *

Secondary Parent or Guardian's Name

Secondary Email Address

Secondary Phone Number

Preferred Method of Communication *

Emergency Contact and Authorized Pickup

Emergency Contact's Name *

Relationship to the participant *

Emergency Contact's Phone Number *

Please list the names and phone numbers of all adults authorized to pick up participant: *

Please list the names of anyone NOT authorized to pick up participant:

Do you have any pickup password or identification requirements? If so, please list them:

Health, Safety, and Accessibility

Please list any allergies, including food, medication, and environmental allergies:

Please list any dietary restrictions:

Please list any medical conditions our staff should be aware of:

Please list any accessibility needs or requested accommodations:

Please list any behavioral, sensory, learning, or communication considerations that may help the staff support the participant:

Primary Physician's Name and Phone Number: *

Health Insurance Provider: *

Permission to seek emergency medical treatment: *

Yes

No

Confirmation that the participant can safely take part in supervised, hands-on activities (Yes/No) *

Participant Interests and Experience

What does the participant hope to learn or experience?

Participant's areas of interest, including cars, science, engineering, art, design technology, building, racing or museums:

Please list any previous experience using tools or participating in hands-on activities:

What is the participant's comfort level working in a group?

Please list any activities the participant especially enjoys:

Please list anything that may make participation difficult or uncomfortable:

What helps the participant feel successful in a new environment?

Demographic and Program Data

Race or Ethnicity (Optional)

Gender Identity (Optional)

Household Zipcode (Optional)

Number of People in the Household (Optional)

Does the participant attend a Title 1 School?

Does the Participant qualify for reduced-price meals?

Would financial assistance make future programming more accessible?

Required Agreements

Participant Behavior Expectations:

I understand that participants are expected to follow staff instructions, treat others respectfully, and participate safely and appropriately. Serious or repeated behavioral concerns may require a parent or guardian to pick up the participant early.

Sign-In and Sign-Out Procedures:

I understand that my child must be signed in and out by a parent, guardian, or authorized adult. Participants will only be released to individuals listed as authorized for pickup, and identification may be required.

Photo and Media Release:

I give permission for my child to be photographed or recorded during camp and for those images or recordings to be used by the San Diego Automotive Museum for educational, promotional, social media, website, and grant-reporting purposes.

I do not give permission for my child to be photographed or recorded for external use.

Liability Waiver:

I understand that camp activities may include supervised movement, games, crafts, experiments, Museum exploration, and other age-appropriate hands-on activities. I acknowledge the ordinary risks associated with participation and authorize my child to participate.

Cancellation and Refund Policy:

I understand that cancellations made at least two weeks before the camp start date are eligible for a refund. Cancellations made fewer than two weeks before the camp start date are nonrefundable.

Parental/ Guardian Signature

Clear

Date of Signature