SHADES OF 2 SHADES OF BLUE. Summer Camp 2015 . 2. 2015 Registration Form. Please select one of the following
SHADES OF 2 SHADES OF BLUE. Summer Camp 2015 . 2. 2015 Registration Form. Please select one of the following
SHADES OF 2 SHADES OF BLUE. Summer Camp 2015 . 2. 2015 Registration Form. Please select one of the following
SHADES OF 2 SHADES OF BLUE. Summer Camp 2015 . 2. 2015 Registration Form. Please select one of the following

SHADES OF 2 SHADES OF BLUE. Summer Camp 2015 . 2. 2015 Registration Form. Please select one of the following

  • View
    7

  • Download
    0

Embed Size (px)

Text of SHADES OF 2 SHADES OF BLUE. Summer Camp 2015 . 2. 2015 Registration Form. Please select one of the...

  • 2 SHADES OF BLUE Summer Camp 2015

    www.ourshadesofblue.org 2

    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 OUT Amusement 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 Freeman c/o Shades of Blue 3540 Donegal Way Snellville, GA 30039

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

  • 3 SHADES OF BLUE Summer Camp 2015

    www.ourshadesofblue.org 3

    Parent Information

    Parent/Legal Guardian First/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)

  • 4 SHADES OF BLUE Summer Camp 2015

    www.ourshadesofblue.org 4

    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

    Fulton County Aviation Community Cultural Center SOLD OUT: Off June 15th19th Fulton County Aviation Community Cultural Center Capacity 25 Students: Off June 22nd26th Atlanta Technical College Capacity 25 Students: Off 200 Fee Includes field trip transportation and admission to the Six Flags Amusement: Off Georgia Piedmont Technical College Grades 46 and Grades 710: Off FirstMLast: Address: City: State: Zip: County: Home Tel: Business Tel: Cell: Email: At which numbers can we best reach you: Custodian Parent: Off Legal Guardian: Off Court Ordered Caregiver: Off Company: Address_2: City_2: State_2: Zip_2: County_2: FirstMLast_2: Address_3: City_3: State_3: Zip_3: County_3: Home Tel_2: Business Tel_2: Cell_2: Email_2: At which numbers can we best reach you_2: Company_2: Address_4: City_4: State_4: Zip_4: County_4: Indicate with whom the child lives check only one: Off Both Parents: Off Mother: Off Father: Off Other: Name: Phone Number: Relationship to Child: removing the student during the Camp: Off Do parents have shared parental responsibility: Off Allergies: Medications: Name of Doctor: