*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
Summer Camp 2009!
REGISTRATION FORM
CHILD______________________________________
AGE/GRADE ____________
PARENT’S NAME ______________________________________
ADDRESS___________________________________
PHONE # _______________________________
CELL # ________________________________
E-MAIL_________________________________
EMERGENCY CONTACT ____________________
TEL. # ___________
PRESCHOOLERS SUMMER FUN – Ages 3-4 – session 1: June 8-12th session 2: June 15-19th 9:00-11:30. Your
child’s preschool may be over but not at the Center. Come and join this week of continued fun. $150 + $10
reg. _____
MYSTERY WEEK CAMP– session 1: June 22nd-26th session 2: June 29-July 3 - 9:00-11:30 Ages 5 & up.
Each day will be filled with a new adventure theme. We'll be doing everything from cooking to arts and crafts to candy making!
$150 + $10 reg._____
SUMMER SCIENCE AND 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.
Session 1: June 22nd - 26th, $175_____
Session 2: August 3rd - 14th, $350 ______
Robotics Workshop 7 & up, 9-12, Aug. 17-21 $220 ___
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 ________
