C RE ED &
SUMMER CAMP 2014 REGISTRATION FORM
PLEASE PRINT AND FILL OUT COMPLETELY. USE SEPARATE FORM FOR EACH PAYOR
Residency: Is your primary residence within the Ann Arbor Public School District? Yes q No q Do you have a current Rec&Ed scholarship? Yes q No q Pending q ID#_____________________ Change in address or phone for registrant since last registration? Yes q No q Change in address or phone for payor since last registration? Yes q No q
CLASS & CAMP SELECTIONS CAMP SELECTIONS CAMP ID#
CAMP TITLE
#2 PARTICIPANT INFORMATION #1 PARTICIPANT INFORMATION
FEE
Office Use _______ of ________ Batch # ____________ Trans # ____________
Office Use
FIRST NAME ______________________________________________ LAST NAME ______________________________________________ q CK q CA ADDRESS_____________________________CITY _______________
q CC q CR
ST ______ ZIP ______________ PHONE ________________________ # _____________ BIRTHDATE_______________ GENDER: M q F q GRADE ___________
Total $__________
SCHOOL CHILD WILL ATTEND IN FALL 14 _________________________________
Registering a child for a camp includes permission for that child to participate in any scheduled field trips. REQUIRED INFORMATION: FOR YOUTH ENROLLING IN CAMP
SHIRT SIZE CHILD: q S qM qL ADULT: q S q M qL qXL qXXL
Disc. ___________
EMERGENCY CONTACT NAME _________________________________________________________________ PHONE: (__________) __________________________________ DOES YOUR CHILD HAVE ANY ALLERGIES OR MEDICAL CONDITIONS? q NO q YES (EXPLAIN) _____________________________________________________________________________ ____________________________________________________ DATE ___________________________ SIGNATURE ______________________________________________
CAMP SELECTIONS CAMP ID#
#2 PARTICIPANT INFORMATION
CAMP TITLE
Office Use
FEE
FIRST NAME _____________________________________________ LAST NAME _____________________________________________
q CK q CA q CC q CR
ADDRESS____________________________CITY _______________ ST ______ ZIP ______________ PHONE _______________________
Registering a child for a camp includes permission for that child to participate in any scheduled field trips. REQUIRED INFORMATION: FOR YOUTH ENROLLING IN CAMP
# _____________
BIRTHDATE_______________ GENDER: M q F q GRADE __________
Total $__________
SCHOOL CHILD WILL ATTEND IN FALL 14 _______________________________
Disc. ___________
SHIRT SIZE CHILD: q S qM qL ADULT: q S q M qL qXL qXXL
EMERGENCY CONTACT NAME _________________________________________________________________ PHONE: (__________) __________________________________ DOES YOUR CHILD HAVE ANY ALLERGIES OR MEDICAL CONDITIONS? q NO q YES (EXPLAIN) _____________________________________________________________________________ ____________________________________________________ DATE ___________________________ SIGNATURE ______________________________________________
Payor Name
(Person paying for classes(es) activities
FIRST NAME _____________________________________ LAST NAME____________________________________________________ ADDRESS _______________________________________________________________________________________________________ STREET
Please complete entire section
ST
Make check payable to: AAPS (ANN ARBOR PUBLIC SCHOOLS) Do not send cash
2
Include payment: Credit from Rec&Ed account:
ZIP
HOME PHONE (_______) ________________________________ WORK PHONE (_________)__________________________________ EMAIL ____________________________________________________________ BIRTHDATE________________ GENDER: M q F q
PAYMENT METHOD:
Credit cards
CITY
1
$ ___________________
q CHECK q CREDIT CARD q SCHOLARSHIP # __________________ q CREDIT ON REC & ED ACCOUNT
$1 donation to the Rec&Ed Scholarship Fund q
Name _______________________________________________________________________________________ Print your name exactly as it appears on the credit card qVISA q Mastercard q AM EXPRESS Total Fee (Required) $ ________________________________________
Sorry we cannot accept debit cards at this time Card # _____________________________________________ Exp. Date _____________ CVV# ________________ 3-DIGIT SECURITY CODE
SIGNATURE (REQUIRED) __________________________________________________________________________
Amount Paid: $_______________
3
Mail entire form to: Rec&Ed SUMMER CAMP 1515 S.Seventh St. Ann Arbor, MI 48103
I agree to pay above total amount according to the card issuers agreement and the REC & ED Refund/Credit policy as listed in this catalog.
REGISTER AT WWW.AARECED.COM
Rec&Ed 2014 SUMMER CAMPS 45