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Registration Form
KIDS | WEEK 1: JUNE 12-16 REGISTRATION DEADLINE: JUNE 5, 2017o Dance, Stories and Art | Grades K-2 | $60o Ladybugs, Tarantulas and Butterflies – OH MY! Grades K-2 | $60
KIDS | NO CLASSES: JUNE 19-23 AND JUNE 26-30
KIDS | WEEK 2: JULY 3-7 NO CLASS ON TUESDAY, JULY 4 REGISTRATION DEADLINE: JUNE 26, 2017o Fun Under the Sea | Grades K-2 | $60o Word Art | Grades K-2 | $60o Catapult Painting | Grades 3-5 | $60o Sprout House | Grades 3-5 | $60
KIDS | WEEK 3: JULY 10-14 BEAVERCREEK CAMPUS ONLY REGISTRATION DEADLINE: JULY 3, 2017o Animal Acts | Grades 3-5 | $60o Jr. Journalism & TV Reporting | Grades 3-5 | $60
Please check one or more classes and complete, sign and return this registration form to: College for Kids and Teens, PO Box 570, Springfield, Ohio 45501. Questions? Contact Kanesha Hall at 937.328.6079 or [email protected].
Student’s Name: ___________________________________ Parent/Guardian Phone ______________________
Address __________________________________________ City__________________________ Zip _______
Date of birth ______________________________________ Grade Level _______________________________
Email Address _____________________________________ o Do Not Email
Clark State Discount Students, faculty and staff of Clark State can receive a $10 discount when registering students for a class. Note: Day camp fees are automatically discounted for all registrants. Clark State Email Address ___________________________________ Payment Must Accompany Registration
o Check enclosed (amount) $ _________(Make check or money order payable to Clark State Community College.) Parent/Guardian PermissionI grant permission for the above named child to enroll in Clark State’s College for Kids Program 2017. Signature of Parent/Guardian _________________ Date ____________________________________________
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Registration Form
Please check one or more classes and complete, sign and return this registration form to: College for Kids and Teens, PO Box 570, Springfield, Ohio 45501. Questions? Contact Kanesha Hall at 937.328.6079 or [email protected].
TEENS | WEEK 1: JUNE 12-16 REGISTRATION DEADLINE: JUNE 5, 2017o Comparative Planetology | Grades 6-9 | $70o Geospatial Technology | Grades 6-9 | $70 o Future Nurses of America | Grades 10-12 | $70 o Intro to Medical Lab Technology | Grades 10-12 | $70
TEENS | NO CLASSES: JUNE 19-23
TEENS | WEEK 2: JUNE 26-30 REGISTRATION DEADLINE: JUNE 19, 2017o Digital Comic Illustration | Grades 6-9 | $70o Destination Improvisation | Grades 6-9 | $60o Pre-Med Camp | Grades 10-12 | $70
TEENS | NO CLASSES: JULY 3-7
TEENS | WEEK 3: JULY 10-14 REGISTRATION DEADLINE: JULY 3, 2017o Creative Writing & Theatre Arts | Grades 7-12 | $55SATURDAY WORKSHOP ONLY, JULY 15, 2017
Student’s Name: ___________________________________ Parent/Guardian Phone ______________________
Address __________________________________________ City__________________________ Zip _______
Date of birth ______________________________________ Grade Level _______________________________
Email Address _____________________________________ o Do Not Email
Clark State Discount Students, faculty and staff of Clark State can receive a $10 discount when registering students for a class. Note: Day camp fees are automatically discounted for all registrants. Clark State Email Address ___________________________________ Payment Must Accompany Registration
o Check enclosed (amount) $ _________(Make check or money order payable to Clark State Community College.) Parent/Guardian PermissionI grant permission for the above named child to enroll in Clark State’s College for Teens Program 2017. Signature of Parent/Guardian _________________ Date ____________________________________________
Last First Middle
Day Camp Registration Form
KIDS | WEEK 1: JUNE 12-16 REGISTRATION DEADLINE: JUNE 5, 2017o Dance, Stories and Art and Ladybugs, Tarantulas and Butterflies – OH MY! | Grades K-2 | $100
KIDS | NO CLASSES: JUNE 19-23 AND JUNE 26-30 KIDS | WEEK 2: JULY 3-7 REGISTRATION DEADLINE: JUNE 26, 2017o Fun Under the Sea and Word Art | Grades K-2 | $100o Catapult Painting and Sprout House | Grades 3-5 | $100
KIDS | WEEK 3: JULY 10-14 REGISTRATION DEADLINE: JULY 3, 2017o Jr. Journalism & TV Reporting and Animal Acts Grades 3-5 | $100
TEENS | WEEK 1: JUNE 12-16 REGISTRATION DEADLINE: JUNE 5, 2017o Comparative Planetology and Geospatial Technology | Grades 6-9 | $120o Future Nurses of America and Medical Lab Technology | Grades 10-12 | $120
TEENS | NO CLASSES: JUNE 19-23 TEENS | WEEK 2: JUNE 26-30 REGISTRATION DEADLINE: JUNE 19, 2017o Digital Comic Illustration and Destination Improvisation | Grades 6-9 | $110
Student’s Name: ___________________________________ Parent/Guardian Phone ______________________
Address __________________________________________ City__________________________ Zip _______
Date of birth ______________________________________ Grade Level _______________________________
Email Address _____________________________________ o Do Not Email
Clark State Discount Students, faculty and staff of Clark State can receive a $10 discount when registering students for a class. Note: Day camp fees are automatically discounted for all registrants. Clark State Email Address ___________________________________ Payment Must Accompany Registration
o Check enclosed (amount) $ _________(Make check or money order payable to Clark State Community College.) Parent/Guardian PermissionI grant permission for the above named child to enroll in Clark State’s College for Kids and Teens Program 2017. Signature of Parent/Guardian _________________ Date ____________________________________________
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Day Camps are a combination of two classes to offer students a full day of camp at a low cost. NOTE: Day Camps are subject to change each year based on teacher, campus and classroom availability. Please check one or more
camps and complete, sign and return this registration form to: College for Kids and Teens, PO Box 570, Springfield, Ohio 45501. Questions? Contact Kanesha Hall at 937.328.6079 or [email protected].
