Personal Information - Lausanne Collegiate School

Big deal Program Registration
Lausanne Summer Links 2010 // Personal Information
Big deal Registration Grades 7 & 8
Personal Information
STUDENT NAME
ADDRESS
HOME PHONE #
DATE OF BIRTH
GRADE IN FALL 2010
T-SHIRT SIZE
PARENT 1 NAME
E-MAIL
CELL NUMBER
WORK NUMBER
PARENT 2 NAME
E-MAIL
CELL NUMBER
WORK NUMBER
EMERGENCY CONTACT 1
RELATION
PHONE
HEALTH CONCERNS: What should this school be aware of (include emotional and physical)? Attach
additional pages if needed.
ALLERGIES AND ASTHMA: Please list allergies, symptoms exhibited and treatment.
CURRENT MEDICATION: Please list regular medication the student takes (include inhaler). Send with
parent’s signature, in most current container, with prescription label and instructions for its
administration.

Parent’s Statement
I understand there is a $35 non-refundable application fee. I have read and fully understand
the Refund Policy and registration information. Lausanne Summer Links reserves the right
to refuse enrollment with no refund to students who demonstrate disruptive or unsafe
behavior. Summer Links at Lausanne reserves the right to cancel any camp or program that
does not meet the minimum enrollment requirements. I authorize the summer program
director to arrange for emergency treatment by qualified personnel for my child. I give
authorization for Lausanne Summer Links to use my child’s photograph in any future web or
print advertisement or publicity. I give permission for my child to participate in Lausanne
Summer Links transportation and field trips. (Each camp will send out additional forms with
detailed information about field trips.)
Having read and understood the Parent’s Statement printed above, I sign this application:
Signature:
Date:
Registration, Payment, and
Refund Information
application and a non-refundable application fee of $35.
form that corresponds with the grade level of the child.
you may make copies or print additional forms off the Web site.
Summer Links) or credit card.
reserve each participant’s place.
must be made in writing and submitted to the Lausanne Links office
(written note or e-mail).
in the order in which applications are received. You will be notified
enrollment form and a receipt with the Lausanne School’s federal tax
ID number and summer totals.
programs in which he or she is enrolled.
enrollment requirements. Under-enrolled courses may be cancelled.
REFUND POLICY:
students affected by such a change or cancellation to other available
.

Big Deal Program Registration
STUDENT NAME
ADDRESS
HOME PHONE #
DATE OF BIRTH
GRADE IN FALL 2010
Pre-Summer June 1 - June 4
Football Camp (9:00 a.m. – 12:00 p.m.) $125 + $10 (Lab Fee)
Week One June 7 - June 11
BeforeCare
Art Studio
Boys Lacrosse
Girls Basketball
Upper School 101
AfterCare
(7:30 a.m. – 9:00 a.m.)
( 9:00 a.m. – 12:00 p.m.)
( 9:00 a.m. – 12:00 p.m.)
( 9:00 a.m. – 12:00 p.m.)
( 12:30 p.m. – 4:00 p.m.)
( 4:00 p.m. – 6:00 p.m.)
(Circle) M T W T F
(Circle) M T W T F
x $5.00 a day
$125 + $15 (Lab Fee)
$125 + $10 (Lab Fee)
$125
$125
x $10.00 a day
TOTAL FOR WEEK ONE
Week two June 14 - June 18
BeforeCare (7:30 a.m. – 9:00 a.m.)
(Circle) M T W T F x $5.00 a day
Boys Basketball ( 9:00 a.m. – 12:00 p.m.)
$125
Chess (To register visit www.chesscamp.us or call at Arlene Kleiman 901-276-4663)
Fashion Fever
AfterCare
( 9:00 a.m. – 12:00 p.m.)
( 4:00 p.m. – 6:00 p.m.) (Circle) M T W T F
$125 + $25 (Lab Fee)
x $10.00 a day
Lausanne Palooza Campout June 18 $35 (Circle) If signed M T W up for T Fcamp $50 Campout ONLY
TOTAL FOR WEEK TWO
Week three June 21- June 25
BeforeCare
(7:30 a.m. – 9:00 a.m.) (Circle) M T W T F x $5.00 a day
Tennis
School of Rock
( 9:00 a.m. – 12:00 p.m.)
( 9:00 a.m. – 4:00 p.m.)
$125
$280
Theater Explosion
AfterCare
( 9:00 a.m. – 12:00 p.m.)
( 4:00 p.m. – 6:00 p.m.)
(Circle) M T W T F
$125
x $10.00 a day
TOTAL FOR WEEK THREE
Week four June 28 - July 2
BeforeCare
EXTREME
(7:30 a.m. – 9:00 a.m.)
(9:00 a.m. – 4:00 p.m.)
(Circle) M T W T F x $5.00 a day
$250
AfterCare
( 4:00 p.m. – 6:00 p.m.) (Circle) M T W T F x $10.00 a day
Lausanne Palooza Campout July 1 $35 If signed up for camp $50 Campout ONLY
TOTAL FOR WEEK FOUR

Week Five July 5 - July 9
BeforeCare
(7:30 a.m. – 9:00 a.m.) (Circle) M T W T F x $5.00 a day
EXTREME (9:00 a.m. – 4:00 p.m.) $280
Science in Action ( 9:00 a.m. – 12:00 p.m.)
$125 + $70 (Lab Fee)
Chef’s Academy ( 9:00 a.m. – 12:00 p.m.)
$125 + $25 (Lab Fee)
AfterCare
( 4:00 p.m. – 6:00 p.m.)
Week Six July 12 - July 16
(Circle) M T W T F
x $10.00 a day
TOTAL FOR WEEK FIVE
BeforeCare (7:30 a.m. – 9:00 a.m.)
(Circle) M T W T F x $5.00 a day
Photography
Soccer
( 9:00 a.m. – 12:00 p.m.)
( 9:00 a.m. – 12:00 p.m.)
$125 + $25 (Lab Fee)
$125
AfterCare
( 4:00 p.m. – 6:00 p.m.) (Circle) M T W T F x $10.00 a day
TOTAL FOR WEEK SIX
Combination program fees
To enroll in programs combining BeforeCare and AfterCare, simply
fill out the registration form with your choices of classes and camps.
Full Day Combo Program
June 7 – August 6 (8 weeks)
Excluding the week of July 19
9:00 a.m. – 4:00 p.m
$1640.00 + lab fees _____ ($120.00 savings)
Full Day Combo Program + BeforeCare Only
June 7 – August 6 (8 weeks)
Excluding the week of July 19
7:30 a.m. – 4:00 p.m.
$1840.00 + lab fees _____ ($120.00 savings)
Week Seven July 26 - July 30
BeforeCare
(7:30 a.m. – 9:00 a.m.) (Circle) M T W T F x $5.00 a day
Dodgeball
( 9:00 a.m. – 12:00 p.m.) $125 + $5 (Lab Fee)
Movie Makers
Scrapbooking
( 9:00 a.m. – 4:00 p.m.)
( 9:00 a.m. – 12:00 p.m.)
$225
$125 + $25 (Lab Fee)
AfterCare
Lausanne Palooza
( 4:00 p.m. – 6:00 p.m.)
Campout July 30
(Circle) M T W T F
$35 If signed up for camp
x $10.00 a day
$50 Campout ONLY
TOTAL FOR WEEK SEVEN
Full Day Combo Program + AfterCare Only
June 7 – August 6 (8 weeks)
Excluding the week of Juy 19
9:00 a.m. – 6:00 p.m.
$2040.00 + lab fees _____ ($120.00 savings)
Full Day Combo Program + BeforeCare and AfterCare
June 7 – August 6 (8 weeks)
Excluding the week of July 19
7:30 a.m. – 6:00 p.m.
$2185.00 + lab fees _____ ($175.00 savings)
Week Eight August 2 - August 6
BeforeCare
(7:30 a.m. – 9:00 a.m.) (Circle) M T W T F x $5.00 a day
Ace the College Essay ( 9:00 a.m. – 12:00 p.m.)
$125
Middle School Bootcamp
Cheerleading
AfterCare
( 9:00 a.m. – 12:00 p.m.)
( 9:00 a.m. – 12:00 p.m.)
( 4:00 p.m. – 6:00 p.m.)
(Circle) M T W T F
$125
$125
x $10.00 a day
TOTAL FOR WEEK EIGHT
Total
Cost of selected weeks or programs
including lab fees + Before and AfterCare
or
Cost of Combination Plan (see above )
including lab fees and Camp-outs