May 12, 2017 - Office Use Only: Received on_____________________. Please return to Danielle Morton at the Tuscaloosa Car
Summer Enrichment Camp 2017
TechXploration
TCS’s ALL COMPLETED FORMS MUST BE SUBMITTED TO SCHOOLS BY May 12, 2017 Please Note: Transportation is Not Provided
School:
2016-17 Grade:
Name
Date of Birth
Race
Street Address City
State
Zip
Home Phone
Work Phone
Cell Phone
Parent /Guardian
E-Mail
Home Language
Gender (Circle) Female Male In the event that the parent/guardian cannot be reached, please list an emergency contact. Emergency Contact Name Phone Emergency Contact Name
Phone
“In the event of a medical emergency, and if in our sole judgment and circumstances permit, we will make a reasonable attempt to contact the parents or legal guardian or the emergency contact person(s) named above. If school administrators are unsuccessful in contacting such persons, I/we authorize and give my/our consent for school administrators to take such action as they deem necessary in their sole discretion, including contacting a physician or other healthcare provider and for emergency medical treatment to be administered to my/our child. Tuscaloosa City Schools shall not be responsible for any medical or hospital costs.” Yes __________ No ____________ If no, what shall we do? List medical problem and/or medications: Does your child have allergies? Yes
No
If yes, describe:
Summer Enrichment ends at 5 p.m. daily. Who will pick up your child/children? Name Phone Please send a note if you are sending someone else to pick up your child/children. If the designated person does not pick up on time, whom should we call? Name Phone
I am interested in being considered for a scholarship to help cover cost for summer camp.
The Summer Enrichment Program is from 8-5, Monday – Thursday, June 12-15, 2017. The camp will be held at the Tuscaloosa Career and Technology Academy for upcoming 4th-8th graders. Breakfast served from 7:30 – 8:00 if your child wishes to eat. Lunch and snacks served as well. All at no cost!
You must register your child for a full week of camp, which will equate to two half-day camps. On the back of this form, rank the camps in the order of interest for you and /or your child. Camp administrators will work to place students in the top camps of their choice. You will be contacted with additional details regarding your child’s placement in the summer enrichment program. Enrollment will be offered on a first-come, first-served basis due to a limited number of spaces. For more information, visit our website at www.tuscaloosacityschools.com/summer.
Office Use Only: Received on_____________________ Please return to Danielle Morton at the Tuscaloosa Career and Technology Academy
Summer Enrichment Camp 2017
TechXploration
STUDENT NAME: ________________________________________ SCHOOL: _______________________________________________ Directions: Please rank the camps in order of interest by using 1, 2, 3, etc. Camps administrators will work to meet interests. Please note that enrollment and placement is based on first-come, first-served basis due to limited spaces. Tuscaloosa Career and Technology Academy Camp Offerings Upcoming 4th-8th Graders ____Adventures in Nature ____Bridge to Success ____Coding ____Culinary ____Engineering: “E”magination ____Health Science ____Oh, I’m on TV? A Race Against Time ____Summer Beauty Camp for Teens
Office Use Only: Received on_____________________ Please return to Danielle Morton at the Tuscaloosa Career and Technology Academy
