Summer Enhancement Camp 2018
The Summer Enhancement Camp 2018 will begin on Wednesday May 30th and will end on Thursday June 21st. The camp will be held at the Southeastern Laboratory School on Monday - Thursday from 8:30am - 12:30pm with 8:15am drop off. Snacks will be provided. Please use this form to register your camper. Campers must be at least 5 entering Kindergarten up through those completing 8th grade. Your camper's spot will not be reserved until payment has been received. The cost of the camp is $175 per camper. Information for mailing payment is included in this form. You must submit a separate form for each camper. Questions? Please contact Dr. Melanie Lemoine at (985) 549-5234 or melanie.lemoine@selu.edu
Camper's Last Name *
Your answer
Camper's First Name *
Your answer
Name Students Prefers (If different from above) *
Your answer
Home Address (Street Numer and Name)
Your answer
Home Address: City
Your answer
Home Address: State
Your answer
Home Address: Zip
Your answer
Parents' Names *
Your answer
Email Address *
Your answer
Phone Number
Your answer
Cell Phone (Mom) *
Your answer
Cell Phone (Dad) *
Your answer
Cell Phone (Other)
Your answer
Student Information *
Student Information: Age when camp starts *
Your answer
Grade Completed During 2017-2018 School Year *
Your answer
Academic Information
The Summer Enhancement Camp is designed to assist campers in maintaining their reading and math skills during the month of June. Instruction will be provided in small groups in a hands-on, interactive way. To assist the Summer Enhancement Camp teachers, please provide the following information.
What is your child's current level in Math?
Your answer
What is your child's current level in Reading?
Your answer
Please list any services your child receives at school. (Ex: tutoring, speech therapy, special education services)
Your answer
Allergies? Health Concerns? Other considerations? Please describe below.
Your answer
Emergency Contact Information
If you cannot be reached in the event of an emergency, please list the names and contact information for TWO local people (family, neighbors) who may assume temporary care of your child until you are available.
Emergency Contact: Name *
Your answer
Emergency Contact: Phone Number *
Your answer
Emergency Contact: Name *
Your answer
Emergency Contact: Phone Number *
Your answer
Please list the names (In addition to those listed above) with whom your child may leave school (Ex. carpooling with another student's parent)
Your answer
Do we have permission to transport your child to the hospital if we can't reach you? *
Can the doctor on duty treat your child? *
If no, please list the name and contact information of the doctor that may treat your child.
Your answer
In case of an emergency, I (the parent or guardian) will be responsible for all bills incurred while receiving treatment and transportation. *
No medication of any kind will be administered during Summer Enhancement Camp. Parents are welcome to come to the Lab School to administer medication for their child/children. No medication may be brought to school by campers at any time. *
Name of person providing information *
Your answer
Relationship to Camper *
Your answer
Consent Form
Permission for Use of Video and/or Photographs

I grant permission to Southeastern Louisiana University's Summer Enhancement Camp to make videotapes, photographs, and/or sound recordings separately or in combination, of my child for educational and/or recruitment purposes. I also understand that these videotapes, photographs, and/or sound recordings may be used on the Southeastern web site. I understand that my child may be videotaped and/or photographed in learning events. Minors in photos and/or videos will be identified by first name only. All video/photo footage will remain in the property of Southeastern Louisiana University and College of Education. When I electronically submit this, I am indicating that this page was read and that I am agreeing to the use of photographs, videotapes, and/or sounds recordings of my child for web or printed publication.

*
Payment
The cost for the camp is $175 per camper. Please make checks payable to SELU and be sure to include: 1) the camper's name in the memo line and 2) your Driver's Licenses Number and State. Bring or mail payment to Dr. Melanie Lemoine, Department of Teaching and Learning, SELU 10749, Hammond, LA 70402. DEADLINE for applications and payment is Friday May 4, 2018.
Questions?
For additional information or if you have any questions, please contact Dr. Melanie Lemoine at (985) 549-5234 | (504) 236-8670 or melanie.lemoine@selu.edu
Submit
Never submit passwords through Google Forms.
This form was created inside of Southeastern Louisiana University. Report Abuse - Terms of Service - Additional Terms