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The Berea City Club/Frank Spurlock Summer Science Camp Registration

CAMP DATES

June 26 – June 30, 2017

Location:
NORTH END FOUNDATION
628 North Rocky River Drive | 440-234-0609

Registration NOW OPEN!

PAYMENT AND ADDITIONAL EMERGENCY FORMS MUST BE COMPLETED VIA MAIL/OR AT THE OFFICE LOCATED AT 634 WESLEY DRIVE, BEREA OH 44017

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)