Winter Mini - Camp 2006

Information

Camper's Name: __________________________________________________

Age/Grade Level/Birth date: __________________________________________

Parents Name: ___________________________________________________

Address: _______________________________________________________

Home Phone: _____________________  Work Phone:____________________

Please Circle

Friend of the Museum                      Yes                    No

Registering for Day(s)           Monday    Tuesday    Wednesday    Thursday    Friday

Emergency Contact

Name:___________________________________________________________

Relationship:______________________________________________________

Phone No:________________________________________________________

Fees

Number of camp sessions_______ X fee_________=____________

Plus Before/After Camp                                                    +____________