Parent/Guardian:   

Address 1:   

Address 2:   

Daytime Phone:   

Cell Phone:   

Email:   

Participant’s Name:   

Grade for 2011 SY:   

Emergency Contact:   

Emergency Phone:   

Summer Camp:   

Dates:   

Time:   

Comments:   

Photo Release:
I authorize ScienceSouth and any media authorized by ScienceSouth to take and use without payment any photographs, audio and/or video of my child as needed for public relations, marketing, social media, advertising, or internal training purposes.

Over-time charge/Pick-up
Camp concludes at 1:30 pm. All children should be picked up by 2:00 pm. Children left passed 2:00 pm are subject to an overtime charge of $5/every five minutes late.

Parents will be mailed additional camp information that will need to be signed and returned by the beginning of the first day of camp.