SCRAP Bin
Summer Camp Registration 2011
Child’s name:
__________________________________________________
Parent’s name: __________________________________________________
Parent’s cell:
__________________________________________________
Parent’s e-mail: __________________________________________________
Age: _______________
Amt Paid: ________
Date Paid: ________
Check -or- Cash
Are there any food allergies or medical conditions of which SCRAP Bin staff should be aware? If so,
please explain:
Y
N
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
In case of emergency, whom should we contact?
Name: __________________________________________________
Cell:
__________________________________________________
Child’s physician: __________________________________________
Physician’s phone: _________________________________________
June 27-July 1 from 9:00-2:00 (bring a sack lunch)
Limited to 30 students, ages 7-15
Cost per student: $65 for the whole week
SCRAP Bin
105 Folds Drive, Ste 3
Carrollton, GA 30117
770-666-5332
emergency phone: 770-286-2631
www.scrapbin.org