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2015 Registration Form

Please select one of the following “Hands – On” Interactive Camps.

Aviation and Aerospace Camp - June 15th - 20th (8:30AM - 4PM) $300

Fulton County Aviation Community Cultural Center SOLD OUT

Closing Ceremony Aviation Camps June 20th, 2015 2:30PM

Digital Media Film Production Camp - 2 Weeks (9:00 AM - 4:00PM) $250 Per Week

June 15th-19th Fulton County Aviation Community Cultural Center (Capacity 25 Students)

June 22nd-26th Atlanta Technical College (Capacity 25 Students) $250 Per Week, Small Classes- Learn sound and lightening techniques, editing, film production, 3-D technologies and more

Amusement Park Physics Camp - June 26th - June 29th (4Days) (9:00AM-4:00PM) $200 Fee Includes field trip transportation and admission to the Six Flags Amusement Park on June 29, 2015 to validate research and then have fun (Capacity 24 students)

Mathematics Camp - July 26th - 31st (9AM - 4PM) Georgia Piedmont Technical College (Grades 4-6 and Grades 7-10) $300 Training, interactive (not lecture) Math games to build confidence and math literacy.

Fees (Includes - T shirt, Lunch, Snack, Field Trips) Aviation Camp fees include Flight Orientation SOLD OUTAmusement Park Physics Fees Include Admission to Six Flags Amusement Park

Registration Options:• Shades of Blue National website: www.ourshadesofblue.org Events by month• Event Brite link for the Shades of Blue Film camp http://bit.ly/1KB2Qo4 Apply and pay online.• Checks should be payable to Shades of Blue GA and mailed to:

Dr. Yvonne Freemanc/o Shades of Blue3540 Donegal WaySnellville, GA 30039

Applications may also be faxed to: Dr. Yvonne Freeman 770 979-9133

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Parent Information

Parent/Legal GuardianFirst/M/Last: _____________________________________________________________________________

Address: _________________________________________________________________________________

City: _________________________ State: ___________________ Zip: __________ County: ____________

Home Tel: _____________________________________ Business Tel: _______________________________

Cell: __________________________________________ Email: _____________________________________

At which number(s) can we best reach you? _________________________________________________

Check One: Custodian Parent Legal Guardian Court Ordered Caregiver

Employment:

Company: ________________________________________________________________________________

Address: _________________________________________________________________________________

City: _________________________ State: ___________________ Zip: __________ County: ____________

Second Parent:First/M/Last: _____________________________________________________________________________

Address: _________________________________________________________________________________

City: _________________________ State: ___________________ Zip: __________ County: ____________

Home Tel: _____________________________________ Business Tel: _______________________________

Cell: __________________________________________ Email: _____________________________________

At which number(s) can we best reach you? _________________________________________________

Employment:

Company: ________________________________________________________________________________

Address: _________________________________________________________________________________

City: _________________________ State: ___________________ Zip: __________ County: ____________

Indicate with whom the child lives (check only one)

Both Parents Mother Father Other ____________________________________

(if other please specify)

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Emergency Contact

Name: ___________________________________________________________________________________

Phone Number: ___________________________________________________________________________

Relationship to Child: ______________________________________________________________________

Important, Everyone Must Answer the Following Questions:

A. Is there a visitation or Georgia Court order barring either parent or Care Giver from

removing the student during the Camp Yes No

(If yes, please provide a copy of the Georgia Court Order)

B. Do parents have shared parental responsibility? Yes No

These questions are only pertinent to Camp Administration in its effort to protect and ensure the

safety of your child/children.

Important Medical Information

Allergies: _________________________________________________________________________________

Medications: _____________________________________________________________________________

Name of Doctor: __________________________________________________________________________

Special Thanks to Our Partners