REGISTRATION â 2016 PRESCHOOL SUMMER
REGISTRATION – 2016 PRESCHOOL SUMMER CAMPS Lenawee County School District Only / Registration: April 20-22, 2016 2015 Preschool Summer Camps CONTACT INFORMATION STUDENT NAME:
DOB:
PARENT/GUARDIAN: STREET ADDRESS: CITY, ZIP:
COUNTY:
HOME PHONE:
CELL PHONE:
EMAIL: T-SHIRT SIZE: YOUTH
XS (2-4)
S (6-8)
M (10-12)
L (14-16)
XL (Adult)
DAYS & LOCATIONS – Indicate 1 for first choice, 2 for second choice...through choice 4 MONDAYS (Jul 18, 25; AUG 1, 8)
LISD Milton C. Porter Education Center – 2946 Sutton Rd., Adrian
TUESDAYS (Jul 19, 26; AUG 2, 9 )
Madison Elementary School – 3498 Treat Hwy., Adrian
WEDNESDAYS (Jul 20, 27; AUG 3, 10 )
LISD Milton C. Porter Education Center – 2946 Sutton Rd., Adrian
THURSDAYS (Jul 21, 28; AUG 4, 11)
Onsted Village Park – Onsted Hwy., Onsted (entrance next to Fire Department)
ALL CAMPS MEET FROM 10-11:30 AM
REGISTRATION INFORMATION Send or drop off this registration form from April 20-22, 2016 to: LISD Milton C. Porter Education Center Young Children’s Services – Tina Jimenez 2946 Sutton Road, Adrian, MI 49221 OR fax: 263-2890 OR email: [email protected]
Registration Notice: Camps are limited to 35 children on a firstcome, first-serve basis. Child MUST be age 2 by July 20, 2016, up to age 5, not yet entered into kindergarten. A welcome letter with information about the Camp will be sent two weeks prior to Camp. **An Adult MUST attend with his/her child. Cancelation Notice: The LISD kindly requests that if your child will not be able to attend Camp after you submit the registration that you please call or email so a child from the waiting list can be contacted.
MEDICAL INFORMATION It is important to know if your child is subject to seizures, has allergies, etc. Bees are a particular problem during summer months. Please indicate below any pertinent medical information and/or any disabilities needing special accommodations. No Yes If yes, please explain:
PHOTO/VIDEO INFORMATION
OFFICE USE
I hereby grant the Lenawee Intermediate School District (LISD), including the LISD Young Children’s Services permission to use my son/daughter's likeness in a photograph/video in any and all of its publications in relation to LISD Early Childhood Programs, including website entries, without payment or any other considerations. I hereby irrevocably authorize the LISD to edit, alter, copy, exhibit, publish, or distribute LISD Early Childhood Programs photos for the purposes of publicizing the LISD programs or for any other lawful purpose. Names will not be publicized. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my child’s likeness appears. Additionally, I waive any right to royalties or other compensations arising or related to the use of the photograph. I hereby certify that I am the parent or guardian of _______________________________, and do hereby give my consent without reservation to the foregoing on behalf of this person.
For Office Use Only
Date Received
Time Received
I hereby decline to provide permission for the Photo/Video Information request. Parent Name (Type/Print):
Date:
Parent Name (*Signature):
Date:
(*If electronically submitted, the form will be available at Camp for Signature.)
Staff Initials
DOB:
PARENT/GUARDIAN: STREET ADDRESS: CITY, ZIP:
COUNTY:
HOME PHONE:
CELL PHONE:
EMAIL: T-SHIRT SIZE: YOUTH
XS (2-4)
S (6-8)
M (10-12)
L (14-16)
XL (Adult)
DAYS & LOCATIONS – Indicate 1 for first choice, 2 for second choice...through choice 4 MONDAYS (Jul 18, 25; AUG 1, 8)
LISD Milton C. Porter Education Center – 2946 Sutton Rd., Adrian
TUESDAYS (Jul 19, 26; AUG 2, 9 )
Madison Elementary School – 3498 Treat Hwy., Adrian
WEDNESDAYS (Jul 20, 27; AUG 3, 10 )
LISD Milton C. Porter Education Center – 2946 Sutton Rd., Adrian
THURSDAYS (Jul 21, 28; AUG 4, 11)
Onsted Village Park – Onsted Hwy., Onsted (entrance next to Fire Department)
ALL CAMPS MEET FROM 10-11:30 AM
REGISTRATION INFORMATION Send or drop off this registration form from April 20-22, 2016 to: LISD Milton C. Porter Education Center Young Children’s Services – Tina Jimenez 2946 Sutton Road, Adrian, MI 49221 OR fax: 263-2890 OR email: [email protected]
Registration Notice: Camps are limited to 35 children on a firstcome, first-serve basis. Child MUST be age 2 by July 20, 2016, up to age 5, not yet entered into kindergarten. A welcome letter with information about the Camp will be sent two weeks prior to Camp. **An Adult MUST attend with his/her child. Cancelation Notice: The LISD kindly requests that if your child will not be able to attend Camp after you submit the registration that you please call or email so a child from the waiting list can be contacted.
MEDICAL INFORMATION It is important to know if your child is subject to seizures, has allergies, etc. Bees are a particular problem during summer months. Please indicate below any pertinent medical information and/or any disabilities needing special accommodations. No Yes If yes, please explain:
PHOTO/VIDEO INFORMATION
OFFICE USE
I hereby grant the Lenawee Intermediate School District (LISD), including the LISD Young Children’s Services permission to use my son/daughter's likeness in a photograph/video in any and all of its publications in relation to LISD Early Childhood Programs, including website entries, without payment or any other considerations. I hereby irrevocably authorize the LISD to edit, alter, copy, exhibit, publish, or distribute LISD Early Childhood Programs photos for the purposes of publicizing the LISD programs or for any other lawful purpose. Names will not be publicized. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my child’s likeness appears. Additionally, I waive any right to royalties or other compensations arising or related to the use of the photograph. I hereby certify that I am the parent or guardian of _______________________________, and do hereby give my consent without reservation to the foregoing on behalf of this person.
For Office Use Only
Date Received
Time Received
I hereby decline to provide permission for the Photo/Video Information request. Parent Name (Type/Print):
Date:
Parent Name (*Signature):
Date:
(*If electronically submitted, the form will be available at Camp for Signature.)
Staff Initials
