2014 Summer Enrichment Program Registration Form

For Students Entering 1st through 7th Grades

Student’s Name: D.O.B. Grade Entering in Fall:

Mailing Address:

Mother’s Name: Email:

Home Phone: Cell Phone: Work Phone:

Father’s Name: Email:

Home Phone: Cell Phone: Work Phone:

Fill out this registration completely, including the Emergency Legal Authorization. Pay a $40 nonrefundable Registration Fee. Student receives a Eagle’s View t-shirt during the first week of program or

camp. A deposit of $20 for each week of program or camp is required. This deposit will be applied to cost for the week of

attendance and is non refundable, but is transferrable.

oMaranatha Christian Academy admits students of any race, color, nationality, or ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of sex, race, color, nationality, or ethnic origin in administration of educational policies, admissions policies, scholarship programs, athletic, or other school administered programs. To do so would be in violation of Christian principles as set forth in God’s Word, the Holy Bible.

FOR OFFICE USE

□ Registration Fee $40 Date: $_________ Emergency Legal Authorization Form □ Eagles View Date: Check #: Amt Paid for Session(s): Enrichment Program Date: Check #: , Amt Paid for Session(s) : □ Eagle’s Camp Soaring Date: Check #: , Amt Paid for Session(s) :

Date: Check #: , Amt Paid for Session(s) :