APPLY ONLINE AT

www.scorecamp.com or submit Application Form Student Name: ____________________________________________________ Parent Name: _____________________________________________________ Address: P.O. Box __________________________________________________ City, State, Zip ____________________________________________________ Phone: ________________________ Cell Phone: _______________________ Email Address: ____________________________________________________ School you attend:________________________2016-2017 Grade Level:____

STUDENT HEALTH FORM Does your child have any illness, allergies or physical disabilities that the camp staff should be made aware of? (  ) Yes  (  ) No Is your child under a doctor’s care at this time?   (  ) Yes  (  ) No Is your child taking any medications?       (  ) Yes  (  ) No If yes, on any of the above questions, please attach a note explaining. Has your child had a tetanus shot?        (  ) Yes  (  ) No In the case of a medical emergency, we will make every effort to contact the parents. If contact is not possible, do you give your permission to seek medical assistance?   (  ) Yes  (  ) No Photo Release: (  ) Yes  (  ) No Camp time contact/emergency phone number_________________ ***I understand that the staff, instructors, volunteers, and CCS Education Foundation are not liable for any accidents that may occur. Parent Signature: _______________________________Date ______________

Science Saves the night! Chase County Schools, 520 E. 9th Street, Imperial, Neb.

Evening Outreach Wednesday, June 14 5:30-8:00 p.m. MT Open to the public.

The AmeriHeart and AmeriBrain will be on display throughout the night and in between the shows by Mad Science and C.A.P.O.W. The AmeriHeart is brought to the camp by the support of the cardiologists from Platte Valley Medical Group. 5:30 – 6:00 p.m. AmeriHeart & AmeriBrain Inflatables 6:00 – 6:45 p.m. Mad Science Show 6:45 – 7:15 p.m. AmeriHeart & AmeriBrain Inflatables 7:15 – 8:00 p.m. C.A.P.O.W.

Thursday, June 15

One hour shows throughout the day at CCS. Open to the public. Shows begin at 8:00, 9:15, 10:30 a.m. and 12:00 noon Presented by

REGISTER CAMPERS FOR THE GRADE THEY ARE IN FOR THE 2016-17 SCHOOL YEAR. Check One      ❏ Grades 1 & 2 (June 13, 14, 15) ❏ Grades 3 & 4 (June 14, 15, 16) ❏ Grades 5 & 6 (June 12, 13, 14, 15) Camp times: 8:00 a.m.-2:00 p.m. MDT T-Shirt Size ❏ Youth Small (6-8) ❏ Youth Medium (10-12) ❏ Youth Large (14-16) ❏ Adult Small ❏ Adult Medium ❏ Adult Large ❏ Adult X-Large

S.C.O.R.E. 2017

Applications are due by June 5, 2017 ($10 late fee after June 5) Due to limited space early registration is advised!! Final Registration Day is Monday, June 5, 7:30-5:00 at Chase County Schools. Would you like to be a camp volunteer? ______Yes _____No

Mail your application and payment to: Linda Lakey, P.O. Box 120, Imperial, NE 69033

Make check payable to: CCS Education Foundation

Science Saves the Day! Presented by

AmeriHeart & AmeriBrain by Interactive Exhibits IMPORTANT: Parents/Guardians please attend final registration day on Monday, June 5, 7:30 a.m.-5:00 p.m. MT at Chase County Schools. Pick up t-shirt, lunch cooler, water bottle and schedule.

Chase County Schools Education Foundation in cooperation with Chase County Schools

520 East 9th Street, Imperial, NE

JUNE 12-16, 2017 8:00 a.m. - 2:00 p.m. Register online at

www.scorecamp.com

What is S.C.O.R.E.?

Science Camps Offer Rewarding Experiences   S.C.O.R.E. is an award-winning science program founded in 1989 by Sue Renken and Marla Smith. The camps offer exciting programs and activities that stimulate young scientists and inspire them through hands-on experiences in a variety of Chase County settings.

S.C.O.R.E. STAFF

Kim Spady Coordinator 308-882-8566 Charlesa Kline Coordinator 308-883-8028 Chris Tomky 5-6 Coordinator 308-883-6513 Brandi Dannatt 1-2 Camp 308-340-3217 Jordyn Haake 1-2 Camp 308-529-2598 Sonya Schilke 3-4 Camp 308-882-6207 Chelsey Losey 3-4 Camp 308-999-1271 Ellen Brogie 5-6 Camp 402-841-0365 Amanda Kimble Equipment 308-883-0622 Sindi Nevarez Assistant Equipment 308-414-1531 Michaela Cochran Hospitality 308-883-3794 Darcie Boman Hospitality 402-469-7139 Linda Lakey Registration 308-882-8869 Jacci Paisley Snacks 308-883-6462 Jason Speck Site Coordinator 308-882-6943 Chelsea Zuege Volunteers 308-882-0010 Black Brick Software Website Tech Angie Paisley Nurse 308-882-8485

1-2 GRADE CAMP

These young scientists will engage in educational and entertaining interactive programs that explore the exciting world of chemistry and physical science. The students’ imaginative curiosity will be sparked by hands on sessions involving the study of plant, animal, earth, environmental and health sciences. The POWER of science will soar in these eager scientists!

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3-4 GRADE CAMP

Hands on experiments will entice students through investigations in chemistry and physical sciences. The young scientists will also explore the powerful worlds of plant, animal, earth, environmental and health sciences. We will challenge the students to find their science superpower!

June 14, 15, 16, 2017 8 a.m. - 2 p.m. MT Meet each day at CCS June 14 @ Cox’s Pond June 15 @ CCS June 16 @ Champion Lake Bring your lunch daily in the cooler provided by S.C.O.R.E. Camp Cost=$110 www.scorecamp.com

June 13, 14, 15, 2017 8 a.m. - 2 p.m. MT Meet each day at CCS June 13 @ Cox’s Pond June 14 @ Champion Lake June 15 @ CCS Bring your lunch daily in the cooler provided by S.C.O.R.E. Camp Cost=$110 www.scorecamp.com

S.C.O.R.E. is sponsored by the CCS Education Foundation with grant funding provided by: Anonymous Donor, Chase County KENO Funds, the Logan Bauman Memorial Foundation and Upper Republican NRD. Donations from many area businesses, organizations and individuals also help support S.C.O.R.E. Brochure designed and sponsored in part by Johnson Publications, Inc., 2017.

5-6 GRADE CAMP

Interactive and hands on activities will give students the opportunity to explore chemistry and physical sciences. Students will discover the power of science while participating in archery, shooting, water exploration and kayaking along with forensic science and the human body. These students will build their own kites and participate in a zip line challenge with eggs.

June 12, 13, 14, 15 2017 8 a.m. - 2 p.m. MT Meet each day at CCS June 12 @ Cox’s Pond June 13 @ Memorial Park & Champion Lake June 14 @ Fairgrounds June 15 @ CCS Bring your lunch daily in the cooler provided by S.C.O.R.E. Camp Cost = $110 www.scorecamp.com