Chem Girls Program

Come to the Children’s Museum and play with your food!

Your Children’s Museum has partnered with Dr. Anne Rodriguez, Professor of Chemistry at Millikin University to bring CHEMISTRY to you, museum-style! This program will consist of THREE one-day camps JUST FOR GIRLS in 5th through 8th grade.

Camps are held from 9am -12:30pm

All participants will receive a Tshirt, record-keeping journal, and a tote. Lunch will be served daily, so please be sure to fill out the allergy information.

Cost is $10 per class. Scholarships are available, by calling Jami or Katie at 217-423-5437.

**This is a grant-funded program, which allows us to offer this class at such a low price. Many thanks to the She-Gave Women’s Giving Circle, who voted to educate girls about chemistry!

Date and Location - All Camps will be held from 9AM - 12:30PM

September 7 at Children’s Museum of Illinois Classroom	Quantity
$10 - Fun with Food Science! Girls will learn about the scientific method while testing out some fun and delicious chemistry experiments.

October 5 at Children’s Museum of Illinois Classroom	Quantity
$10 - All About Eggs! Girls will perform chemistry experiments using multiple techniques with eggs. Cook an egg with no heat?

November 2 at Millikin University Chem Lab in Leighty-Tabor Hall	Quantity
$10 - Candy Chemistry! Girls will take a tour of a real Chemistry Lab and conduct experiments on sugar to create a multitude of candy concoctions.

Waitlist

If a session is sold out, you may waitlist HERE

General Information

Child Name *

First Name

Last Name

Age of Child *

Shirt Size

Parent/Guardian *

First Name

Last Name

Email *

Verify Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Pickup Authorization

Listed below should be people that you have given permission to pick up your child. If anyone other than the people listed below should pick up your child, you will need to call us at 217-423-5437 and let us know the name of that person. At the time of sign-out the staff will ask for a photo ID to match up with the name. Please advise anyone picking up your child of the above procedures and thank you for your cooperation in this matter!

Adult #1

First Name

Last Name

Adult #1 Phone

Adult #2

First Name

Last Name

Adult #2 Phone

Adult #3

First Name

Last Name

Adult #3 Phone

Photographic/Video Release

Please be aware that photos and video footage taken of guests at Children's Museum of Illinois, particularly during classes, camps, or during special events, are for use by Children's Museum of Illinois only and may be used in audio and visual marketing and promotional materials. All photos are the property of Children's Museum of Illinois.

Check Applicable *

I hereby consent to any publicity, including the use of my child's name and likeness in connection with my child's participation.

I do not consent to any publicity.

Liability Waiver

I am fully aware that my child's participation in programs, services, activities, and events is completely voluntary. In consideration of my child's participation, I individually, and behalf of my minor child and our respective heirs, successors, assigns, and personal representatives, hereby release Children's Museum of Illinois and its officers, employees, voiunteers, and agents (in their official and individual capacities) from any and all liability whatsoever for any and all damages, losses, or injuries to person or property of both in connection with my child's association with, or participation in, activities at, sponsored by, or arising out of the programs, services, activities, facilities, and events. I agree that this Waiver and Release is intended to be as broad and inclusive as permitted by the laws of the State of Illinois, and if any portion hereof is held invalid, it is agreed that the balance of hereof shall, nowithstanding, continue in full legal force and effect.

Date *

(mm/dd/yyyy)

Signature of Parent/Guardian: *

Emergency Medical Treatment Release

In case of medical emergency and you are unable to grant verbal permission for your child to be treated, we request that this form be completed. Naturally, we do not anticipate this permission being needed, but illness and accidents do sometimes occur. We will make every effort possible to contact you before taking action should emergency or hospital care be deemed necessary. Should illness or injury require treatment beyond our efforts the parent or guardian is responsible for transportation and expenses.

Check the following: *

I give permission for my child to receive medical treatment in the event of an emergency, accident, injury, or illness.

I authorize treatment for my child from all emergency medical personnel including but not limited to licensed physicians, emergency responders, nurses, technicians, etc.

I assume responsibility for all costs incurred as part of my child's treatment, transportation, etc in the event of a medical emergency.

Check if Applicable

Food Allergies *

Yes

Please Specify

Non-Food Allergies *

Yes

Please Specify

Any physical, emotional, or behavioral conditions requiring accommodations

Add 3% to my total amount to help cover the payment processing fees