*Please PRINT & MAIL To:
Saddle River Valley Cultural Center 
305 West Saddle River Road
Upper Saddle River, NJ 07458

Georgia Greiner, Director 
201-825-3366 · Fax 201-825-0010
Email Georgia@srvcc.org
Web www.srvcc.org

VACATION WORKSHOPS 2010

                                     REGISTRATION FORM

CHILD______________________________________AGE/GRADE ____________

PARENT’S NAME _________________________________________

ADDRESS______________________________________________________________

PHONE # __________________CELL # ______________E-MAIL-_______________

EMERGENCY CONTACT _______________________________ TEL. # __________­­­­­­­­­­­­­­­­­­_

PLEASE CHECK OFF THE WORKSHOPS YOU WOULD LIKE YOUR CHILD TO  ATTEND.

Preschoolers Summer Fun – Ages 3-5 - 9:00-11:30 - Your child’s preschool may be over but not at the Center. Come and join this week of continued fun.

           $160 + $10 reg. June 14-18 _____                                                                                                                                                 

           $160 + $10 reg.  June 21-25 _____  

Summer Science/Nature Workshop—High Touch-High Tech- 9:00-12:00-Ages 6-up.

(must have completed kindergarten)  Spend the morning exploring in the world of science

& nature.

            Aug. 2-6       $175 ____

            Aug .9-13     $175 ____

Robot Camp- August 23-27 9:00-12:00 Ages 6-up Robots, robots, robots and more robots! Come and build, compete, race and battle join the world of robotics!!  *Robots can be purchased separately at the end of class.    $225 ______   

Mystery Camp Adventure - June 28-July 2 9:00-12:00 Ages 5- up

Each day will be a new surprise and theme. Come join the excitment!

$160 + $10 reg. _______

Fairy Fun - August 23-27, 9:15 AM – 11:45 Ages 5 & up.

Join us as we enter the secret and mystical world of fairies! We will build a fairy home, have a fairy tea party, write a letter to a fairy and so much more!

$160.00

   MEDICAL RELEASE FORM

I hereby give my permission for the Saddle River Valley Cultural Center to proceed with emergency 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 contacts cannot be reached.

**LET US KNOW IF YOUR CHILD HAS ANY ALLERGIES OR SPECIAL NEEDS

PARENT’S SIGNATURE __________________________________DATE ________

****PLEASE establish with us a PASSWORD that must be used by anyone, other than you when picking up your child.               

YOUR CHOICE OF PASSWORD ________