Mail-in Camp Registration


		Mail-in Camp Registration

Interactive Museum
2008 Registration Form

Mr.Mrs.Ms.

^NAME
^ADDRESS
^{CITY                                                            ST.     ZIP}
^{HOME PHONE                                      CELL PHONE}
^E-MAIL
^{EMERGENCY CONTACT}
^{EMERGENCY CONTACT PHONE}
^{CHILD'S NAME}                ^-^-
^{GRADE (entering)            SCHOOL (currently attending)                  BIRTHDATE (MM/DD/YYYY)}BOY     GIRL

Child's health concerns:

Session Information:

        Camp Topic:
                 Dates :

Please make check payable to "The Interactive Museum" and MAIL with this form to:

Interactive Museum -Mad Science Camp
PO Box 453
Middletown, NY 10940

Confirmation letter and directions will be mailed upon receipt of payment