Spring Break 2008 Camp Registration Form

Fill Circle(s) Below

Camp

Dates Ages Price

Notes: 

OO

OO

OO

OO

OO

Ready, Set, Spring!

Spring Into the Real Thing

Spring is in the Stars

Nuts, Bolts and Springs

Spring to Mind-It's all about Me!

3/31/08

4/01/08

4/02/08

4/03/08

4/04/08

5 - 11

5 - 11

5 - 11

5 - 11

5 - 11

$30.00

$30.00

$30.00

$30.00

$30.00

 

 All camps are

9:00am to 4:00 pm.

 

Lunch not provided, but two snacks are, per day.

 

_____________________________   _________________

Name                                                Birthdate (child #1)

_____________________________   __________________

Name                                                Birthdate (child #2)

________________________________________

Name (parent/guardian)

________________________________________

Mailing Address

________________________________________

City, State, Zip

________________________________________

Phone

________________________________________

E-mail

Subtotal:           ________

 

Members, -10%:________

 

Member #:        ________

 

Total:                ________

Contact Jim Hodgin at 260-424-2400 ext 451 for more information.

 

Faxes:

260-422-2899

Early drop off and late pickup are available at $3.00/half hour. Please call Jim for more information.

O Check

 

O Visa

 

O MasterCard

 

O Discover

 

Name on Card: _____________________________________

 

Billing Address for Card: _____________________________

 

__________________________________________________

 

Credit Card #: ______________________Exp: Date:_______

 

Signature:_________________________ 3-digit code: ______

Send to:

 

Science Central

1950 N. Clinton

Fort Wayne, IN 46805

www.sciencecentral.org

**Register before 2/15/08 to receive $10 off total registration cost for campers attending all five days.