2008 PRINTABLE REGISTRATION FORM
1. Child's name _______________________________________________ M___ F___ Telephone_______________
Grade in Fall 2008 ______ Age _____ Birthdate ____________________ TAG _____ Other ___________________
School __________________________________________________ District ______________________________
Health information _____________________________________________________________________________
Special interests _______________________________________________________________________________

Week 1 July 7-11
Period 1 8:30-10:15 Class Title____________________________________________________________________
Period 2 10:30-12:15 Class Title ___________________________________________________________________
Period 3 12:45-2:30 Class Title ____________________________________________________________________
Period 4 2:45-4:30 Class Title _____________________________________________________________________

Week 2 July 14-18
Period 5 8:30-10:15 Class Title_____________________________________________________________________
Period 6 10:30-12:15 Class Title ___________________________________________________________________
Period 7 12:45-2:30 Class Title ____________________________________________________________________
Period 8 2:45-4:30 Class Title _____________________________________________________________________

Week 3 July 21-25
Period 9 8:30-10:15 Class Title_____________________________________________________________________
Period 10 10:30-12:15 Class Title __________________________________________________________________
Period 11 12:45-2:30 Class Title ___________________________________________________________________
Period 12 2:45-4:30 Class Title ____________________________________________________________________

2. Child's name _______________________________________________ M___ F___ Telephone_______________
Grade in Fall 2008 ______ Age _____ Birthdate ____________________ TAG _____ Other ___________________
School __________________________________________________ District ______________________________
Health information ______________________________________________________________________________
Special interests _______________________________________________________________________________

Week 1 July 7-11
Period 1 8:30-10:15 Class Title____________________________________________________________________
Period 2 10:30-12:15 Class Title ___________________________________________________________________
Period 3 12:45-2:30 Class Title ____________________________________________________________________
Period 4 2:45-4:30 Class Title _____________________________________________________________________

Week 2 July 14-18
Period 5 8:30-10:15 Class Title_____________________________________________________________________
Period 6 10:30-12:15 Class Title ___________________________________________________________________
Period 7 12:45-2:30 Class Title ____________________________________________________________________
Period 8 2:45-4:30 Class Title _____________________________________________________________________

Week 3 July 21-25
Period 9 8:30-10:15 Class Title____________________________________________________________________
Period 10 10:30-12:15 Class Title __________________________________________________________________
Period 11 12:45-2:30 Class Title ___________________________________________________________________
Period 12 2:45-4:30 Class Title ____________________________________________________________________

Parent/Guardian ___________________________________________________________________________________
Street address ____________________________________________________________________________________
City _____________________________________________________ State _______________ Zip ________________
Telephone: Cell #____________________ Home #_______________________Work # ___________________________
Email address_____________________________________________________________________________________
Emergency contact name/phone ______________________________________________________________________
Person(s) authorized to pick up child(ren) after class ______________________________________________________
Where did you learn about our Summer Program? ________________________________________________________

Would you like to carpool with another family? ________ From what area/neighborhood? _________________________
May we share your email address with parents interested in carpooling from your area? ___________
May we share your telephone number with parents interested in carpooling from your area? __________

I understand that Education Soaring, Inc. occasionally takes photographs of children in classes for public relations purposes. Names of students are not used in Education Soaring literature. Permission is granted to use my child’s picture without his or her name in Education Soaring literature. Because the news media's policies regarding the use of children's names is different from Education Soaring's policies, I understand that my child will not be allowed to be photographed or interviewed by any media group without me or my representative present or without my permission granted in writing.

Education Soaring instructors and volunteers hold exemplary records as dedicated teachers, volunteers and community citizens. Student safety is the top priority of all Education Soaring staff and every effort is made to ensure the well-being of participants in classes. I release Education Soaring, Inc., its officers, instructors, volunteers and school district personnel where classes are held from any and all liability for injury to my child arising out of his or her participation in the program.

Child__________________________ Parent signature _________________________________Date ____________