200 8 Hiram High School

For Office Use Only

9 ^th Grade Summer Camp

Amt. Paid:

$ __________

Payment Form __________

Registration

Rec’d by _______________

Registration Fee is $15.00

Date __________________

Registration Deadline: May 23, 2008

Camp Date:

Tuesday, August 5, 2008

Time:

6:00-8:00 p.m (dinner will be served)

Camper’s Name _______________________________________ ID#: ____________

Camper’s Address ______________________________________________________

City __________________________________ State ______________ Zip_________

Home Phone (_____)____________________E-mail __________________________

Father’s Name (and/or male guardian)_______________________________________

Home Phone __________________________Work Phone ______________________

Cell Phone ____________________________

Mother’s Name _________________________________________________________

Home Phone _________________________Work Phone _______________________

Cell Phone ___________________________

Please circle camper’s T-Shirt size below:

S

M

L

XL

XXL

(adult sizes)

Authorization and Consent for Medical Treatment: In case of illness or in an emergency, I hereby give

permission to secure any necessary medical treatment for my child during the camp session. I authorize any qualified

physician to render treatment he or she deems necessary upon consultation of the school administration.

Allergies ______________________________________________________________

Physical Problems______________________________________________________

Medications____________________________________________________________

Parent Signature___________________________________Date ________________

Return this application and registration fee to your 8 ^th grade teacher

or

Mail Application and Registration Fee to:

9 ^th Grade Summer Camp

Hiram High School

702 Ballentine Drive

Hiram, GA 30141