DISCOVER …
EXPLORE …

MIDDLE SCHOOL
Sum^20m^19er
CAREER CAMP

Breakfast, Lunch, and Transportation are provided!	_Breakfast, _Lunch, _and _Transportation _are _provided!
www.ccsoh.us

For more information contact Christy Manson
380-997-6125
R E G I S T R A T I O N	F O R M
Sum^20m^19er
CAREER CAMP
JUNE 10-14, 2019 - 8:30 AM-2P M

Fort Hayes Career Center
Construction Arts & Automotive Building
546 Jack Gibbs Blvd.
DEADLINE: May 6, 2019
CAMP CAPACITY: 125 students
Please complete application and fax to (614) 365-8334,
or give the completed form to your school counselor.	 	
Please use pen and print legibly.

STUDENT INFORMATION

Name

Middle School

Home Address (street and number)

City, State, ZIP

Phone					Grade - Fall 2019

PARENT INFORMATION

Name

Home Address (street and number)

Phone (Home)	^(Work)

(Cell)

Email

Bus Transportation Requested:
(Columbus City School Students Only)

Yes	No	(circle one)

CONSENT TO PARTICIPATE

I give my consent for my child to participate in the Columbus City Schools 2019 Middle School Summer Career Camp. I certify that they are physically able to take part in all camp activities. I give my consent for medical or dental treatment in the event of injury or illness and will not hold the Columbus City Schools and/or camp authorities responsible for accidents incurred during the camp.

Name
Signature (Parent/Guardian)

Emergency Contact

Phone

CONSENT TO BE PHOTOGRAPHED

I consent for my child to be photographed and videotaped for the purpose of presentation and marketing.
(Please sign choice below):

Yes  		^No

^This ^activity ^is ^not ^sponsored ^by ^Upper ^Arlington ^Schools.