Summer Camp 2020 Registration Form:
Email address *
Student Name (1) *
Your answer
Student (1) Date of Birth: *
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DD
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YYYY
T-shirt Size *
Your answer
Student Grade Level (1) *
Required
Does child have an IEP: *
Is child in ELL/ESOL Program? *
Is child in Gifted Program? *
Allergies: *
Your answer
Medical Conditions: *
Your answer
Student Name (2)
Your answer
Student (2) Date of Birth
MM
/
DD
/
YYYY
T-shirt Size
Your answer
Student Grade Level (2)
Does child have an IEP:
Is child in ELL/ESOL Program?
Is child in Gifted Program?
Allergies:
Your answer
Medical Conditions:
Your answer
Parent Name *
Your answer
Address *
Your answer
Contact Info (Phone Number) *
Your answer
Emergency Contact Info (Name and Number) *
Your answer
Primary care Physician *
Your answer
Dietary restrictions *
I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill. Please type your First and Last name. *
Your answer
I understand that Balancing The Equation 21st Century Learning, Inc (501c3) will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian. Please type your First and Last name. *
Your answer
Photo Release I hereby give permission for my child to be photographed during the Summer STEM Camp. I understand the photos will be used to keep a journal of activities, to share during power point presentations and/or reports to our donors and for promotional purposes including flyers, brochures, newspaper and on the internet. I understand although my child's photograph may be used for advertising, his or her identity will not be disclosed. I do not expect compensation and that all photos are property of Balancing The Equation 21st Century Learning, Inc. Please type your First and Last name.
I understand that I will have to pay $50 registration fee per child and $400 summer fee for Camp. Fees can be made in person using cash or checks. Fees can also be paid via cash app: $BalancingEquations. There are no refunds. In order for your registration to be considered as complete, your Reg fee must be paid in full. *
Required
Please review our handbook (found online www.balancingtheequation.org) so that everyone is aware of our emergency procedures, discipline policy and etc.
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