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The Frank Spurlock Summer Science Camp Registration

CAMP DATES

June 20-June 24, 2016

Location:
People’s Community Church
631 North Rocky River Drive | 440-234-0609
Rose Cansler, Administrative Assistant

Registration NOW OPEN!

Due to this year’s curriculum, students must have completed 1st grade prior to June 20!!

PAYMENT AND ADDITIONAL EMERGENCY FORMS MUST BE COMPLETED VIA MAIL/OR AT THE OFFICE LOCATED AT 628 WESLEY DRIVE, BEREA OH 44017

Confirmed registered campers should report with parents on Monday, June 20 at 8:45am

 Happy Camping!

Student Name (required)

Date of Birth (required)

Grade Completed (required)

Current School Attending (required)

Parent/Guardian Names (required)

Address (required)

City (required)

State (required)

Zipcode (required)

Phone (required)

Your Email (required)

Shirt Size (required)

Siblings Attending Program

Additional Information

Alternate Pick-Up Authorization

Please list names of individuals besides yourself authorized to pick up your children from camp.

1) Name

1) Relationship to Child

1) Phone Number

2) Name

2) Relationship to Child

2) Phone Number

My child has permission to walk home (required)

Parent/Guardian Enrollment Authorization (required)

 I verify that I am the parent/guardian of the child registered on this form. I understand that the program ends at 4:00 pm (full day) and agree to pick up my child at this time.

Your Name (required)

Relationship to Child (required)

Date (required)