Register for Dino Trackers on July 29, 2024!

We look forward to welcoming your child to the Burke! Please note:

Please review the Privacy Notice for UW Youth Programs before completing this form.
To request disability accommodations, please contact Disability Services Office at least 10 days in advance of the program by calling (206) 543-6450 (voice): (206) 543-6452 (TTY); or (206) 685-7264 (FAX); or dso@uw.edu (email).
Sales are final. We are not able to offer refunds at this time.

APPLYING FOR COST ASSISTANCE?

Burke cost assistance helps youth K–12 participate in a single Burke Museum Takeover program by covering 50% of the full-price program fee. Aftercare fees are not covered by Burke cost assistance.

Will you be applying for cost assistance?

NoYes

Do not register using this form. Before you can register for a Museum Takeover program, please visit the link below to submit an application for cost assistance.

Museum Takeover Cost Assistance Application

If you're application for cost assistance is approved, you will be emailed a link to register for the Museum Takeover program of your choice. Cost assistance is awarded on a first-come, first-served basis and spots have been reserved in each takeover camp for cost-assistance eligible families.

MUSEUM TAKEOVER SELECTION

You are registering for the following Museum Takeover Program:

Dino Trackers (Grades 2-3), July 29, 9 AM - 2:30 PM

Would you like to add 1.5 hours of aftercare for an additional $30?

Camp Cost

Aftercare Cost:

Subtotal:

CAMPER INFORMATION

Camper First Name

Camper Last Name

Pronouns (How should we address your child?)

Birthdate

Please specify your child's pronouns:

School

Grade Entering in Fall

Is this camper attending with a sibling or friend? If so, who?

Allergies/Reactions/Medications: What medical needs should our staff/paramedics be aware of?

Camper Needs: Please share any behavioral and/or physical needs that our staff should be aware of.

PARENT / GUARDIAN INFORMATION

Please note: Only contacts entered below will be authorized to pick up the registered camper. Photo ID required.

Primary Contact/Guardian Information (REQUIRED)

We'll send the registration confirmation to this person.

Primary Contact First Name

Primary Contact Last Name

Primary Contact's Relationship to participant:

Primary Phone

Primary Address

City

State

Postal Code

Primary Email

(Please double check you've entered this email correctly. All camp info will be sent to this email address!)

Secondary Contact (REQUIRED)

Secondary Contact First Name

Secondary Contact Last Name

Secondary Contact's Relationship to participant:

Secondary Phone

Secondary Email

Additional Guardian/Caretaker Authorized to Pick-up Your Child

Additional Contact First Name

Additional Contact Last Name

Additional Contact Phone

CONSENT

Please read through the two consent statements below carefully. You will be asked to confirm that you have read and understood these statements by signing electronically.

Acknowledgement of Risk and Consent for Treatment

Program activities include crafts, gallery exploration, snack and lunch in public outdoor spaces and access to hand sanitizer and restrooms. Risks inherent in these activities include bodily injury or illness due to exposure to infectious diseases, including COVID-19.

Potential environmental hazards include stairs, heights, hand sanitizer stations containing alcohol as the active ingredient, uneven and hard surfaces, allergens, tripping hazards, electrical outlets, choking hazards, earthquake hazards, and sharp edges.

I acknowledge that there are certain risks inherent in this program, including but not limited to those indicated above. I acknowledge that all risks cannot be prevented and I assume those risks are beyond the control of the University staff. I represent that my minor child is able, with or without accommodation, to participate in this program, is able to use the equipment and/or supplies described above, and that they have obtained any required immunizations. Should my minor child require emergency medical treatment as a result of accident or illness arising during the activities, I consent to such treatment. I acknowledge that the University of Washington does not provide health and accident insurance and I agree to be financially responsible for any medical bills incurred as a result of emergency medical treatment. I will notify the Burke in writing if my minor child has medical conditions about which emergency medical personnel should be informed.

Acknowledgement of Risk and Consent for Treatment

Yes, I give my consent

Enter initials

Consent for Use of Personal Data

As described in the Privacy Notice for UW Youth Programs, certain uses of personal data require your consent. This includes Sharing, Featuring, and/or Publishing Photographs, Audio Recordings, Video Recordings, and/or Content Created in a UW Youth Program:

Burke Museum (“we”) would like to use photographs, video recordings, audio recordings, and/or content created in our programs that identify or can identify the participants. Photographs, video recordings, audio recordings, and/or content will be captured and/or created during Museum Takeover Programs which will take place at the Museum in July & August 2024.

The personal data described above may be shared with program stakeholders in optional reporting so stakeholders have information about the program and its effectiveness in meeting its stated goals. This data may also be shared with caregivers, featured on the Burke Museum’s website, or published in the University of Washington and/or Burke Museum’s marketing materials and reports for the purpose of promoting, celebrating, and fundraising. The materials will be public. Once published, personal data contained in the materials may remain public indefinitely.

By checking the box below, you grant permission for the UW to create recordings of the image, likeness, and/or voice of the participant (“Recordings”) in connection with the participant’s involvement in Burke Museum Takeover Programs. You agree the Recordings may take the form of photographs, films, video and audio tapes, CD-ROMs, DVDs, digital files, and/or any other media now known or later developed. UW may use the Recordings at UW’s discretion. You understand that UW’s use of the Recordings may include, but not be limited to, the activities described above.

You understand that neither you nor the participant will be paid for any uses made of the Recordings pursuant to this grant of permission. You waive the right to inspect or approve of the uses of any printed or electronic copy.

You acknowledge that UW exclusively owns all rights to the Recordings, including but not limited to, any copyright or trademark rights associated with the Recordings. To the extent the Recordings include any content created by the participant as part of the Burke Museum Takeover Programs such as drawings, writings, projects, artwork, and other works or creations (“Content”), you, on behalf of participant, hereby grant UW a non-exclusive, perpetual, worldwide, royalty-free, and unlimited license to use, reproduce, distribute, display, and perform, any Content. UW is also granted a non-exclusive, perpetual, worldwide, royalty-free, and unlimited license to create derivative works in any media, now known or later developed, from any Content, and any clips or portions thereof. UW shall own such derivative works; however, in any instance where UW is deemed not to own such derivative work, you, on behalf of the participant, hereby grants UW a license to the derivative works on terms identical to its license granted above.

You, on behalf of yourself and the participant, hereby waive all rights and release UW from, and shall neither sue nor bring any proceeding against any such parties for, any claim or cause of action, whether now known or unknown, for defamation, invasion of right to privacy, publicity or personality or any similar matter, or based upon or relating to the use and exploitation of the Recordings.

You may withdraw your consent at any time by emailing burked@uw.edu. If you withdraw your

consent, we will not engage in the activities described above in the future. A withdrawn consent will not apply to past personal data processing.

Media Release

Yes, I give my consentNo, I do not give my consent

Enter initials

Consent Confirmation

By signing below you agree to have read and understood:

The Acknowledgment of Risk and Consent for Treatment
The Consent for Use of Personal Data and the Privacy Notice for UW Youth Programs available at https://www.washington.edu/privacy/notices/youth/.

Check below to confirm

I understand that I am not required to give my consent for the use of personal data; and I agree to the processing described above for which I marked, "Yes I give my consent." I agree to sign off on this document electronically by typing my name below.

Signature (Please type your full name here)

Date

PAYMENT INFORMATION

Are you a Burke Museum member?

YesNo

Camp Cost:

Member Discount

Aftercare Total:

TOTAL:

How would you like to pay?

First Name

Last Name

Card Number

Code

Billing Zip/Postal Code

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