REGISTER: FREE Project Exploration Winter Break Camp - Jan 3rd - 6th, 2023

Calling All Chicago K-8th Grade Students!

Join Project Exploration for a FREE Winter Break Camp, where you can get to know local wildlife with the Lincoln Park Zoo, learn to code and use it to create animations and models to solve problems, build your own roller coaster, engineer a hydraulic arm to complete basic tasks for you, learn about 3D printers, explore space, and more! Students will be split up by age group and experience a wide array of activities with a small group of other students their age and an instructor.

At PE, our goal is to expose our students to a world of new experiences and opportunities to let them know that the sky is the limit for their dreams! No experience is required to jump into any of our exciting activities, learn new skills, and uncover secret talents. With small numbers of students to instructors, your child will get to explore their interests and tell us the types of activities they want to do more! And all Project Exploration activities are always FREE.

Winter Break Camp will include twice daily meals and snacks, all the supplies your child needs to do activities, and an optional field trip on Friday, January 6th.

REGISTER FOR FREE WINTER BREAK CAMP:

Register for K-8 Winter and Spring Program Opportunities 2022

Participation is FREE!

"*" indicates required fields

Program Choice

For what program(s) are you registering your student?

Winter Break Camp (Jan 3-6) at 4950 W. Thomas Street

Spring Programs (Feb 6-May 19) at 4950 W. Thomas Street

Spring Break Programs (April 3-7) at 4950 W. Thomas Street

Virtual Opportunities (calendar not yet available, but we will add you to our contact list)

Student Information

Information collected in this form is for Project Exploration's grant reporting and point tracking purposes only. Your family's personal information will never be shared with other parties without your written consent. Please register each child individually. Refresh this page after submitting to register additional students in kindergarten through 8th grade.

Student First Name*

Student Last Name*

Does your child attend Chicago Public Schools (CPS)?*

Yes

CPS Student ID*

ID number can be found on report card or progress report, parent portal, student ID card, or you may call your child's school for assistance. Sharing this information can help us connect you to additional resources, such as free internet in your home!

Student Email (if applicable)

Date of Birth*

Gender Identity*

Female

Male

Non-Binary

Transgender

Race/Ethnicity*

Choose all that apply

Black/African American

Hispanic/Latinx

White/Caucasian

Asian/Pacific Islander

Native American

Other

Does your child have an IEP?*

Yes

Please share a copy of your child's Individualized Education Program (IEP) so we can ensure proper accommodation's

Drop files here or

Max. file size: 128 MB.

Student Street Address*

We will send your child's free STEMkit to the address listed here. Please ensure it is an address at which you can receive mail.

City*

State*

Zip Code*

Student's Current School*

School not listed? Insert Here*

School(s) Zipcode*

Please check the zipcode of the school your youth attend. If unlisted, click "Other"

Other School Zip Code

ZIP / Postal Code

Current Grade*

This form is for K-8 students only. Please register high school students at www.projectexploration.org/register-hs.

You live outside our service area, but we are happy to have your student join us virtually! However, a donation is required to cover the cost of your student's supplies, as well as offset the cost of a young person in Chicago who would not otherwise be able to participate in such a high-quality STEM program. Thank you for supporting Project Exploration's mission of ensuring low-income students, students of color, and girls living on the South and West sides of Chicago have free access to high-quality STEM learning opportunities!

Parent/Guardian and Emergency Contact Information

Parent/Guardian Name*

First Last

Parent/Guardian Email*

Parent/Guardian Phone*

Are you comfortable receiving text messages?*

Yes

Additional Emergency Contact Name*

First Last

Emergency Contact's Relationship to Student*

(e.g. parent, aunt/uncle, grandparent, friend, etc.)

Emergency Contact's Phone*

Additional Family Information

Project Exploration programs are free thanks to funding we receive from the Illinois Department of Human Services. They require that we report back about family living situations, which help them decide on increased funding. Additionally, your responses to these questions can help Project Exploration better support your child and family, if desired. The information provided is not shared with any other third party and is kept strictly confidential. Please share as much or as little as you are comfortable.

This student...*

Choose the descriptions which best fit, or choose the options "none of the above" or "prefer not to disclose" if you don't want to share or if you don't wish to receive additional services.

Housing Status*

Choose one that best fits your family

This student lives in a home that is owned by our family

This student lives with relatives

This student lives in a home that is rented (e.g. house, apartment)

This student lives in a DCFS placement or foster home

This student lives in temporary housing or is homeless

Income Source(s)*

Choose as many that apply to your family

Employment

Pension

TANIF

Earnfare

Social Security

Unemployment Insurance

Otter (SSDI, Child Support, VA Benefits)

Child's Future Aspirations*

College/University

Technical School

Employment (no further education beyond high school)

Unsure

Photo of Student

Upload a photo of your student here to be featured on our website and social media if they earn the "Explorer of the Week" title

Drop files here or

Accepted file types: jpg, gif, png, Max. file size: 128 MB.

How did you hear about Project Exploration?

Your Friend/Family Member's Name

Please include first and last name of the parent/guardian.

Other

please describe how you heard about Project Exploration

Consents

Program Permission*

As the parent/guardian of the above student, I acknowledge and give permission for them to participate in Project Exploration programs. The program seeks specifically to address the following 6 core elements, with a focus on science, technology, engineering and math: • Improving academic performance • Recreation, sports, cultural and artistic activities • Positive adult mentors • Life skills education • Parental involvement • Service learning

I agree.

Media Policy*

I hereby grant Project Exploration and its agents, and each of them, the unrestricted, irrevocable and unrestricted license and right to use my appearance, form, likeness, and voice contained in the photographs, film, or recordings of me or the named minor listed below (as applicable) including identifying information, and to distribute such images and recordings for promotional, editorial trade, advertising, packaging, selling, licensing, commercial or educational purposes in any manne or medium whether now or hereafter devised, throughout the world, in perpetuity. I understand images may be licensed with a stock agency and that the images may be included in stock files. Any funds earned by Project Exploration from such activities will be used to support Project Exploration and its charitable and educational mission.

I am at least 18 years of age. I have read the below, fully understand its contents, and have full legal right to sign this release on behalf of myself and the minor(s) enrolled within.

TeenREACH Program*

I give my permission to the Illinois Department of Human Services and its designees to collect and record data on my students. This gathering may include, but is not restricted to the following: Surveys and/or interviews about their knowledge, attitudes, skills, and behaviors in regards to risk-taking behaviors and habits, education and educational resources, positive relationships, career choices, connection to the community, and overall satisfaction with the Teen REACH program. Academic and school department data from report cards and other school reports. I understand that the purpose of these surveys and interviews is to document the impact of the Teen REACH sites for any public presentations of their findings and that my student(s) will not be individually linked to their responses. In addition, I understand that I can take back my permission at any time and that my permission automatically stops when the student leaves the Project Exploration program

I agree to PE's TeenREACH policy.

Release of Information

I authorize my child's school to release the following information Project Exploration on a quarterly basis: grade point average, photocopies of report cards, school attendance rates, grade achievement information and graduation information.

I agree

Donation

Out-of-Service-Area Fall Registration

Price:

My family would like to make an additional donation:*

Yes

Additional Donation Amount*

When you click submit, you will receive a confirmation email. If there is a payment due, you will be redirected to Paypal. Please complete the payment by clicking the button "Pay with debit or credit card." If you have any difficulties, please call or text our STEM@home Hotline at 312-772-6634.

Total

REGISTER: FREE Project Exploration Winter Break Camp – Jan 3rd – 6th, 2023