Commodore Camp Innovation 2021 Registration: Frazier ES/MS (June 14th - June 17th)
Please fill out the online registration form below to register for the 2021 Commodore Camp Innovation. If more than one student will be attending please make sure to fill out a separate form for each student.

Students must attend all day Monday - Thursday 9AM to 2:00PM (current grades K-5). Please bring a bagged lunch.

Registration fee is covered through grant funding: COST FREE (normally $75.00)

Completed forms are to be returned within two weeks of registration to:

ATTN: Sarah D'Urzo
Frazier Commodore Camp Innovation
1 Intermediate Unit Drive, Coal Center, PA 15423

Space is limited to 48 students and is available on a first come first serve basis. You will receive an email confirmation within 3 days upon receiving your online registration to confirm your spot is held. Registrants will receive official confirmation of enrollment once all forms are received.

LOCATION OF CAMP: 142 Constitution St, Perryopolis, PA 15473

Photo Release Form and Release from Reliability Form can be found at https://sites.google.com/iu1.org/innovationanddesign/student-programs
Contact Information
Parent/Guardian (s) Name *
Primary Phone Number *
Please list the number in which you can best be reached in case of an emergency.
Alternate Phone Number
Please list a second number, that we can use to reach you in case you cannot be reached at the primary phone number. If the number is for another family member, please indicate their name along with the number.
Email *
Street Address *
City *
State *
Zip Code *
Student Information
First Name *
Last Name *
Gender *
Required
Birthdate *
School Child Attends *
Grade (current) *
Photo Release
Please complete the information below as well as returning the signed IU1 Photo Release Form.
Your child's picture may be taken for the local newspaper or for special program presentations. Kindly give us permission or decline permission to include your child in pictures by indicating your response below. *
Please make sure to sign and return the formal Photo Release Form found at http://www.iu1.org/services/innovation-and-design.
Required
Medical Form Release
Emergency and Medical release information for Commodore Camp Innovation 2021. Please complete all information below in order to successfully register for Commodore Camp Innovation 2021. Please mark all fields that DO NOT apply with N/A.
Parent/Guardian Name
Please indicate if the information is different from the above contact information.
Allergies *
Medications *
Medical Conditions *
Dietary Restrictions *
Emergency Contact *
In case of an emergency, please contact (other than parent).
Physician/Physician Phone Number *
Handicap Accessibility *
Required
Handicap Accessibility
If "Yes" was selected above, please expalin requirements below.
Commodore Camp Innovation Policy Information
BEHAVIOR POLICY - Commodore Camp Innovation reserves the right to remove disruptive students from the program. In this unlikely event, the parent(s) will be required to pick up their student immediately.

TECHNOLOGY POLICY - Personal electronic devices (iPods, iPads, Kindles, Nintendo, etc.) are not permitted during the week of Commodore Camp Innovation, unless otherwise noted by the instructor. Cell phones are the ONLY exception however they must remain stored in the student's backpack, etc. only to be used in a case of emergency. If a student is using technology inappropriately the item will be kept aside by an instructor for the remainder of the day. Multiple infractions will result in the student being dismissed from Commodore Camp Innovation. No refund will be provided.
Commodore Camp Innovation Payment and Forms
To complete registration please mail Camp Legal and Photo Release forms, Sarah D'Urzo, Commodore Camp Innovation, 1 Intermediate Unit Drive, Coal Center, PA 15423. Once all forms and payment are received you will receive official email confirmation of acceptance to Commodore Camp Innovation.

Forms can be found at www.iu1.org/services/innovation-and-design

Register early, sessions fill up fast. Spots will be held for TWO WEEKS upon receiving the online Commodore Camp Innovation Registration Form. If forms have not been received in that time frame, the spot will be released.

For more information or any questions please contact Sarah D’Urzo at sarah.durzo@iu1.org.
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