VACATION WORKSHOP 2008 REGISTRATION FORM
CHILD’S NAME ____________________________AGE/GRADE ___________
PARENT’S NAME _________________________________________________
PHONE # _________________CELL # _______________ EMAIL ______________
EMERGENCY CONTACT _________________________ PHONE ______________
PLEASE CHECK OFF THE WORKSHOPS YOU WOULD LIKE YOUR CHILD TO ATTEND
AGES 6 & UP; 9:00 – NOON
___ NOVEMBER 5 & 6 (Teacher's Convention) Ages
6 & up
Lego
Star Wars and Motorized Machines $95 + $20 for supplies
___ JANUARY 18 (Martin Luther King Jr.’s Birthday)
Into the Wild $45 Ages 5 & up
___ FEBURARY 15 & 16 (Winter Break) Ages 6 & up
Diggin' For Dinosaurs, Rockin' Rocks, & Crystal Creations
$100
____ APRIL 12 & 13 (Spring Break)
Spring Fling $95 Ages 5 & up
MEDICAL RELEASE FORM
I herby give my permission for the Saddle River Valley Cultural Center to proceed with ermergency treatment
for
_______________________________ (child’s name) my ___________ (son/daughter) in the event of
accidental injury or illness in the event either the family or the emergency contact cannot be reached.
* LET US KNOW IF YOUR CHILD HAS ANY ALLERGIES OR
SPECIAL NEEDS
PARENT SIGNATURE __________________________________ DATE ________
Please enable us with a PASSWORD that must be used by anyone other than you to pick up your child.
Your choice of password ________________
