SUMMER CAMP REGISTRATION FORM
A completed registration form and check for payment are necessary to register for summer camps. A confirmation letter will be sent by mail upon acceptance. Information and consent forms will be mailed in May. The Museum grants refunds only when a cancellation is received four weeks before the session begins. A $25 processing fee is required for refunds. Questions? Call 919.733.7450, ext. 555 or ext. 520. PLEASE COMPLETE ONE (1) FORM PER STUDENT AND PRINT CLEARLY. Age requirements: Grade levels stated in program descriptions are those of the 2008 – 2009 school year. Campers must be four years old by January 1, 2009, to be eligible for PreK-Kindergarten classes. A copy of the birth certificate or its equivalent must be submitted with the regis tration form for PreK children. Please double-check to make sure that you sign your child(ren) up for the appropriate age groups. We cannot make exceptions. The NC Museum of Natural Sciences is committed to providing equal opportunity to all applicants. * PLEASE NOTE: All Museum Summer Camps will be peanut free. STUDENT INFORMATION
STUDENT’S NAME ADDRESS CITY, STATE, ZIP ALLERGIES OR OTHER MEDICAL IMPAIRMENTS AND/OR LEARNING DIFFICULTIES: AGE DATE OF BIRTH
MOTHER’S NAME: HOME PHONE: WORK PHONE: CELL PHONE: E-MAIL: MEMBERSHIP #: EMERGENCY CONTACT NAME: PERSONS AUTHORIZED TO PICK UP STUDENT:
FATHER’S NAME HOME PHONE: WORK PHONE: CELL PHONE: E-MAIL: EXP. DATE: PHONE:
SECTION 1: PREFERRED CLASSES (LIMIT 2 PER CHILD)
PROGRAM NAME SESSION # DATE(S) FEE
WOULD YOU LIKE TO DONATE TO THE SUMMER CAMP SCHOLARSHIP FUND?
SCHOLARSHIP DONATION $ SUBTOTAL FOR CLASSES $
SECTION 2: ALTERNATIVE CHOICES (PLEASE LIST IN ORDER OF PREFERENCE. IF PREFERRED CHOICES ARE FULL YOU WILL BE REGISTERED FOR THE FIRST AVAILABLE CLASS YOU LIST.)
PROGRAM NAME SESSION # DATE(S) FEE
SECTION 3: LUNCHTIME OR TRANSPORTATION OPTIONS
PROGRAM NAME SESSION # DATE(S) FEE
SEND YOUR COMPLETED SUMMER CAMP REGISTRATION FORM AND CHECK TO:
S CHEDULING C OORDINATOR N.C. M USEUM OF N ATURAL S CIENCES 11 W EST J ONES S TREET R ALEIGH , NC 27601-1029
SUBTOTAL FOR LUNCH CARE $ TOTAL AMOUNT ENCLOSED $