Minds On ~ Hands On
Science
Science Camps–2009
REGISTRATION FORM
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:
_________________________
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
