CAMPS

        Robots, Rockets, and Roller Coasters Camp
            From July 21 - 25, 9:00 a.m. to 12:00 noon.  For students who will be entering grades 4, 5, 6, 7, 8, and 9 in the fall costing $125.

CHILD'S NAME   GRADE CHILD WILL ENTER IN FALL

NAME OF SCHOOL CHILD ATTENDS

PARENTS' NAMES    PARENT'S EMAIL

HOME ADDRESS     STREET

CITY   STATE   ZIP CODE   HOME PHONE

WORK PHONE   EMERGENCY CONTACT

Important Please Read

WAIVER

I give my permission for my child to participate in an educational program sponsored by Shenandoah GYSTC.  I understand that all activities will be planned and conducted by certified schoolteachers and GYSTC personnel and that safety precautions will be taken during all activities.  In the event that an accident does occur, I will not hold Shenandoah GYSTC or Coweta Co School System, their employees or volunteers responsible for any accidental injuries.

If  emergency treatment or advice is considered necessary by the GYSTC staff, I understand that the listed physician and parent or guardian will be notified.  If we cannot be reached, I authorize Shenandoah GYSTC to arrange whatever emergency treatment is considered necessary. 

Physician's Na me    Physician's Phone Number

Hospital

Please list any allergies, physical limitations, and special medications.