1. Free Admission, Open to Any Madison County Student WHO WILL BE A 7 th or 8 th GRADER IN THE FALL!!! (Sign-ups limited to the first 20 students) YOU MUST SIGN-UP IN ADVANCE!!! DAILY SCHEDULE : 9:00 - 9:30am Welcome / Demos / Teambuilding Exercise 9:30 - 10:30am Flight Crew Basics 10:30 - 11:30am Break / Flight Training 11:30am - 12:00pm Lunch / Break 12:00 – 4:00pm Flight Training 4:00 – 4:30pm Review / Wrap-up / Closing Complete a Post Event Survey to be entered into the Door Prize drawing (must be present to win)! TO SIGN-UP: A.COMPLETE THE ATTACHED APPLICATION. If you’d prefer an electronic version of the application, e-mail Mr. Marionneaux and he will send you one. B.Make sure the entire form is completely filled out! Missing information may cause your application submittal to be delayed or denied!!! C.CHOOSE ONE of the following options to submit the completed application: 1) E-MAIL (Preferred method #1) application to steve.marionneaux@madison.kyschools.ussteve.marionneaux@madison.kyschools.us 2) FAX (Preferred method #2) application to BMCMS (859-623-2652). 3) MAIL to BMCMS (c/o Mr. Marionneaux), 1428 Robert Martin Bypass, Richmond, KY 40475 4) DROP-OFF at B. Michael Caudill Middle School Main Office during normal business hours. D.No sign-ups by phone! Questions, please call 893-1510 and leave a message. E. Once registered, a confirmation letter or e-mail will be sent with more info about the camp! REMINDER: Only The First 20 Students to Successfully Submit Their Application Will Be Accepted For The Camp!!! YOU MUST SIGN-UP NO LATER THAN 4:00pm, FRIDAY, JUNE 13TH !!!!

2. 2014 STEM Camp Application STUDENT INFO: Name:______________________________________ School:_________________ Grade in the Fall: 7 th 8 th (FIRST) (LAST) Please address any of the following possible situations that might apply for your student (Use back if necessary): 1.Medical Issues/Concerns - ___________________________________________________________________ ___________________________________________________________________________________________ 2. Food Allergies - ____________________________________________________________________________ 3. Other concerns/conditions we should be aware of - _______________________________________________ ___________________________________________________________________________________________ PARENT / GUARDIAN INFO: Name:______________________________ Mailing Address: ________________________________________ (FIRST)(LAST) (STREET ADDRESS) (CITY) (ZIP CODE) Relationship: Mother Father Other: _________________ Primary Contact Phone #: ____________________ Alternate Contact Person Name: ________________________________ Contact’s Phone #: ________________ (FIRST) (LAST) Who will actually be picking up the student each day (if different from Parent/Guardian listed above)? 1. ____________________________________ Contact’s Phone #: ____________________ (FIRST)(LAST) 2. ____________________________________ Contact’s Phone #: ____________________ (FIRST)(LAST) Will student need to be dropped-off earlier than 8:50am? Yes No Picked-up b etween 4:30 and 5pm? Yes No Anything else we need to be made aware of regarding dropping off/picking up of your student? (if so, explain) ___________________________________________________________________________________________ Daily Meals Requested: (Check which ones apply) ____ Will bring own. ____ Breakfast. ____ Lunch. Will your student have to miss any of the camp? (Circle one) Yes No If Yes, please explain why and any details. ___________________________________________________________________________________________ WE WILL END OUR CAMP FRIDAY NIGHT WITH A POT-LUCK MEAL AND FAMILY SHOWCASE FROM 6 TO 8:30PM. WE WILL PROVIDE THE BURGERS, HOTDOGS, BUNS, DRINKS AND PAPERWARE/FLATWARE. - Will you all be attending? (Circle one) Yes No If so, how many people will likely attend? _____ (approx.) - If attending, what side-dish could you bring: ___ Baked Beans ___ Green-Bean Casserole ___ Tossed-Salad w/ Dressing ___ Chips ___ Desserts ___ Lett./Tom./Pickles ___ Condiments (Mayo/Mustard/Ketchup) Other: _________________________ Some brief info about the camp: 1. Breakfast and Lunch will be provided Monday through Friday by the Summer Feeding Program if desired (choose above). Or, students may bring their own lunch! Also, students may bring their own snacks. However, we will likely provide an afternoon snack and drink for them. 2. If necessary, students may be dropped-off as early as 8:00am and picked-up as late as 5:00pm. 3. Attire: Casual wear, to include shorts (proper length), t-shirts and tennis shoes or sneakers. No inappropriate clothing allowed. WE MAY BE DOING PHYSICAL ACTIVITY IN THE GYM AND OUTSIDE at times, so dress for it! 4. Students will be handling remote-controlled quad-copters so SAFETY IS A MAJOR CONCERN! Safety glasses will be provided for use. 5. We expect proper behavior at all times!!! Horseplay will not be tolerated!!! IF THERE ARE ANY PROBLEMS, A STUDENT MAY BE SENT HOME EARLY AND/OR TOLD NOT TO RETURN TO THE CAMP!!!