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CAMP ReGISTRATION FORM - International School of Indiana

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ISI Summer Camp Program<br />

Registration Form<br />

Camper Name: _____________________________________________________________________________<br />

Date <strong>of</strong> Birth:_________________________ Age:____________________ Grade Next Fall:_______________<br />

Current <strong>School</strong>: _____________________________________________________________________________<br />

Parent(s) Name(s): ___________________________________________________________________________<br />

Home Address: ______________________________________________________________________________<br />

Parent Cell Number:_____________________________ Alt. Number: _________________________________<br />

Parent Email Address:_________________________________________________________________________<br />

Indicate Camps you would like your child to register for:<br />

Camp Name Camp #<br />

_____________________________________________________________________________________ $150<br />

_____________________________________________________________________________________ $150<br />

_____________________________________________________________________________________ $150<br />

_____________________________________________________________________________________ $150<br />

m Eligible for ISI Family Discount ($25 <strong>of</strong>f per camp) Use Coupon Code ISI<strong>CAMP</strong> (discount does not apply to extended care)<br />

Indicate if you would like to sign up your child for Extended Care: ($50 per session)<br />

m #045 June 17 – June 21; 7am – 9am m #047 June 24 – June 28; 7am – 9am<br />

m #046 June 17 – June 21; 4pm – 6pm m #048 June 24 – June 28; 4pm – 6pm<br />

Please complete payment online at: http://store.isind.org/ISI-Camps-C9.aspx<br />

Or send check payable to:<br />

ISI Summer Camp to <strong>International</strong> <strong>School</strong> <strong>of</strong> <strong>Indiana</strong>, 4330 Michigan Rd, <strong>Indiana</strong>polis, IN 46208<br />

The following adults have my permission to pick up my child from camp (include relationship to child):<br />

____________________________________________________________________________________<br />

____________________________________________________________________________________<br />

____________________________________________________________________________________<br />

I have read, completed, understood and agree to abide by the <strong>International</strong> <strong>School</strong> <strong>of</strong> <strong>Indiana</strong>’s:<br />

m Participation Agreement<br />

m Medical Emergency Form and Release<br />

m Participation Waiver and Release <strong>of</strong> Liability<br />

____________________________________________________________________________________<br />

Mother and/or Guardian <strong>of</strong> Camper’s Signature<br />

Date<br />

____________________________________________________________________________________<br />

Father and/or Guardian <strong>of</strong> Camper’s Signature<br />

Date

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