Sun Foundation Registration 2001 Art & Science in the Woods: (6/14-18)

A. Identification H. Major Classes


Name (first,last)
Age, Birthdate
Parents' Address
Mailing Address
City/Town, State, Zip
County, Male/Female
Phone/Day, Phone/Evening

  
B. Medical Information  

Allergies, special physical/learning needs, medications, etc...


  
C. Fees for Classes/Supplies  

Early Bird

 $90
Regular $95
  $120
Late $10 added surcharge after May 20
Waiver Teacher's assistant: 1/2 of tuition fee for 1 dependant free
Scholarship For students in financial need
  Other


 
D. ASW 98 T-Shirt Optional  
Small M 38/40 L 42/44 XL 46/48 -- $18  
E. Registration Checklist  
Form Fees T-Shirt Fee
Self addressed business size envelope (33 cents for 1-2, 55 cents for 3-4)		  
F. Consent Form (to be signed by parent/responsible adult)  

I hereby consent to the use of my photograph and/or work reproduced in Art & Science in the Woods, in Sun Foundation brochures, publications, slide presentations, etc... Participants in Sun Foundation activities are not covered by medical or accidental insurance. Each participant must furnish his or her own coverage. Participant or parent permission is needed to call emergency equipment in an emergency. As a participant (or as a participant under 18 yrs of age), I hereby agree to save harmless & indemnify the Sun Foundation, Bob or Joan Ericksen or Blue Herron Farm, its trustees and employees, Bob or Joan Sloan, Low Point Washburn School District, Department of Conservation, State of Illinois, Marshall State Fish and Wildlife Area from any responsibility for any accident, injury or damage that may occur as a result of participants act of ommissions. In any case of accident, I consent to emergency medical care provided by ambulance or hospital personel.

_________________________________________________________
Signature, Date

  
G. Transportation/Car Pool  

I am interested in car pooling/transportation with other students
from my area Yes No