Minds On ~ Hands On
Science

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Registration for Science Camp

Science Camps–2009

REGISTRATION FORM

      

Click here to view and print a .pdf version

                                                         

Name: _____________________________       __________________________________

                      Last Name (of Student/ students)                                                                  Parent’s First & Last (if different from students)

Address: ________________________________________________________________

                                                                                  Street City, State, Zip Code

Family E-Mail: _________________________________ Phone: ____________________

 

Emergency Contact Person: __________________________ Cell: _________________________

 

Emergency Phone Number: __________________________ Alt. number: __________________

 

            Fill out registration forms below – 1 box per student

Indicate Grade for 2009-2010 School Year  - List current age 

 

 

Student’s First & Last Name: ________________________________ Grade _____ Age ______

 

___ Week 1         June 1-4 “CSI Memphis”                                   9 AM – 12 PM or 1 PM – 4 PM

 

___ Week 2    June 8-11 “Earth, Sky, & Reasons Why            9 AM – 12 PM or 1 PM – 4 PM

 

___ Week 3     June 15-18 “Fun with Physics”                          9 AM – 12 PM or 1 PM – 4 PM

 

___ Health Issues (allergies, medications, illnesses)____________________________________

 

___ Carpool with which family (if applicable) ________________________________________

                                                 

 

 

Student’s First & Last Name: ________________________________ Grade _____ Age ______

 

___ Week 1         June 1-4 “CSI Memphis”                                   9 AM – 12 PM or 1 PM – 4 PM

 

___ Week 2    June 8-11 “Earth, Sky, & Reasons Why            9 AM – 12 PM or 1 PM – 4 PM

 

___ Week 3     June 15-18 “Fun with Physics”                          9 AM – 12 PM or 1 PM – 4 PM

 

___ Health Issues (allergies, medications, illnesses)____________________________________

 

___ Carpool with which family (if applicable) ________________________________________

                                                                                                                    

*Register by

1 CAMP

2    CAMPS

3 CAMPS

May 1 – May 15

$85

Save $5

$159        Save > $20

$229        Save > $40

After May 15

$90

$170        Save > $10

$250        Save > $20

*Discount per student. Not combined with other students.

 

 

                                                                                                                      Fee Summary

 

Student 1 ________________

 

Student 2 ________________

 

Total        ________________

 

 

Parent’s Signature: ________________________________date: ______________

 

Please note: Classes will be filled on a first-come, first serve basis. Registration fees are due at the time of registration. The fee cannot be refunded after 5/15/09. Instructor may cancel classes and refund entire amount if a minimum class size of seven (7) is not met.

 

 MAIL REGISTRATION FORM, MEDICAL WAIVER & PAYMENT TO:

 

Patti Jelinek

6663 Spencer Forrest Cove West

Memphis, TN 38141

 

 


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