Science Is Not A Spectator Sport
Summer Science Enrichment Registration Form
August 4-8, 2008

Your child's name ______________________________ Age______
School _________________________________ Grade __________
T-shirt size (circle one) Youth: 10-12 14-16  Adult: S M L XL

Parent name _____________________________________________
Address ________________________________________________
City/State/Zip____________________________________________

Telephone (Home) ________________________________________
Telephone (Work) ________________________________________
Pager/Cell Phone _________________________________________
E-mail _________________________ Internet access at home? ____

Emergency Contact Person _________________________________
Telephone ______________________________________________

Medical Concerns (allergies, medication, etc.) ___________________
_______________________________________________________
_______________________________________________________

Other Pertinent Information
1) People other than parents who may pick up
    your child _______________________________________________

2) Friends attending together ________________________________

3) Are you interested in carpooling if others inquire? Y / N

Location: Woodland Mound Park, Juneberry Shelter (rain or shine)
Tuition: $205.00 (Click here for more information about cost.)

Send registration including payment to:
John Farmer Science
774 Shoreham Court
Cincinnati, OH 45255

Refund Policy: There is a $25.00 cancellation fee. Full payment is
forfeited if cancellation occurs after July 28th.

Questions? Call 388-0774.