2019 Eureka Summer Camps Enrollment
This form is to enroll in the 2019 Summer Camp program at Eureka Public Schools.  All camps include breakfast from 8:30-9:00 and Lunch 11:30--12:00. The grade level requirement is the completed grade level. Camps vary in cost please see description on the registration form.  A student is not enrolled until payment is received in full. You may drop a check or money order off at the Eureka Elementary office between 10:00-1:30.  After June 10th payments can be made between 8:30-9:00 or 11:30-12:30 in the Elementary gym.  Questions about a specific camp please contact the coach through email which is available on the camp description.  A separate form is required for each student.
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Student Name *
Parent Name *
Grade Completed
Child Date of Birth
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/
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YYYY
1st Contact Name and Number
 (Summer Daytime)
2nd  Contact Name and Number
 (Summer Daytime)
At the end of the camp my child:
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List any person(s) with permission to pick up your child:
Emergency Contact Person
Medical Information:
health problems or concerns, medications or allergies, preferred doctor, anything else we should know?
Basketball Grades K-7
Cost:  $50 .Dates:  July 8-11 9:00-11:30 Students will be grouped by age to learn the fundamentals of basketball along with sportsmanship and fun! Drop off at Elementary. ssartori@teameureka.net
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Science Week! Grades K-7
No cost!  Sponsored by 21st CCLC  July 15-18 9:00-11:30. Students must commit to all four days. Students will be grouped by age to explore and create a variety of Science projects.  Drop off at Elementary alamb@teameureka.net
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Football Grades 2-7
Cost:  $25  Dates: July 22-23 9:00-11:30 Fundamentals of football safety, procedures and sportsmanship.  Drop off at football field. tutter@teameureka.net
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Kindergarten Camp
Cost:  $50  Dates: July 22-25 9:00-11:30 Kindergartners will have fun while learning and exploring!  Drop off at Elementary. clucey@teameureka.net
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Volleyball Grades 5-7   9:00-11:30
Cost:  $50 .Dates: July 22-25 9:00-11:30 The basic fundamentals of volleyball. (Must have 10 registered for camp to take place) Drop off at Elementary cjacobson@teameureka.net
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Volleyball Grades 2-4   12:00-2:30
Cost:  $50 .Dates: July 22-25 12:00-2:30 The basic fundamentals of volleyball. (Must have 10 registered for camp to take place) Drop off at Elementary. cjacobson@teameureka.net
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Art Grades 1-3
Cost:  $25 .Dates: July 22/23 12:00-2:30  Drop off at Elementary. ( limit of 15)  kcomstock@teameureka.net
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Art Grades 4-6
Cost:  $25 .Dates: July 24-25  12:00-2:30 Drop off at Elementary. (limit of 15)  kcomstock@teameureka.net
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Softball/Baseball Grades 2-7
Cost:  $50 .Dates: July 29-Aug 1 9:00-11:30.  Fundamentals of softball and baseball. Drop off at Elementary. kcarvey@teameureka.net
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Please add up the amount due and record.
I hereby authorize the staff of EPS  Summer program to give consent to medical treatment in the case of an emergency.   *
I hereby give permission for mutual exchange of information between the EPS Summer program and the school regarding health and safety issues, food program status, immunization, academic records, and ethnicity. *
I acknowledge that the EPS Summer Program and/ or its sponsors may utilize film, print,and digital images of a student or a family, which may be taken during involvement in the Summer Program activities.  I consent to such uses and hereby waive all rights for compensation. *
Signature: *
I hereby authorize my typed name below to represent my signature on behalf of the Summer Recreation Program.
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