SUMMER REGISTRATION 2017
Please include a non-refundable $75 deposit (towards registration/tuition) to reserve your child’s placement in
the program. FINAL PAYMENT IS DUE 2 WEEKS PRIOR TO CAMP START. There is a one-time $25 registration fee for
new students. Only registered students will be permitted to enter the Learning Center Labs during our summer programs.
Student Name
Age
Parent/Guardian Name
Address
Relationship to Student
Address (if different from student)
Mobile Phone
Parent Email Address
Emergency Contact and Relationship to Student (provide other than above)
Phone
Check the program(s) for which you are registering and circle the class/extended choice:
5/24 - 5/26 Computer Mini ($150 anytime 9am-3pm)
5/29 - 6/2
Beginner Code & Robots
6/5 - 6/9
Video Game Design
Please circle choice class or extended option:
6/12 - 6/16 Innovative Thinkers- STEM Camp
$200 9am-Noon camp class only
6/19 - 6/23 Minecraft Challenge
$250 9am-3pm Extended Option
6/26 - 6/30
 Computer games & minecraft, crafts,
movies, board games, etc.
 Includes snack and drink
 Student must bring lunch
Minecraft Creative
7/3 – 7/7 (closed July 4th) Tech Mini ($175 or $215)
7/10 – 7/14 Beginner Game Programmers
Date
7/17 - 7/21
LEGO Simple & Motorized Mechanisms
7/24 - 7/28
Video Game Design
Payment Amount
Check #
or circle: Cash - Credit Card
Student Information (to be completed by parent/guardian)
Student Name: _____________________ School Attended (this 2016-2017): _____________________
Age: _________ Grade Level: _____________
How did you learn about the Technology & Learning Center?
Website
School Advertisement
Magazine
other:
Please list any food allergies or health concerns:
Please list any learning or behavioral disorders that we should be aware of:
Any other special needs/comments?
I hereby consent for my child, ___________________________________, to attend summer courses/camp at the
Technology & Learning Center. I understand that the $75 deposit is non-refundable to reserve seat, and my
balance is due no later than two-weeks prior to the class session.
_________________________________________________
Parent Signature
____________________________
Date