Archaeology No School Day Program Registration Form

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Monday, December 6, 2013, 9:00 a.m. – 4:00 p.m.*

Contact Information

First Name: Last Name:

Email:

 

Student Information

First Name: Last Name:

School: Grade as of Fall 2013: Age:

First Name: Last Name:

School: Grade as of Fall 2013: Age:

 

Parent/Guardian Information

First Name: Last Name:

Address: City:

State: Zip:

Home Phone: Work Phone: Cell Phone:

Relationship to Student:

 

First Name: Last Name:

Address: City:

State: Zip:

Home Phone: Work Phone: Cell Phone:

Relationship to Student:

 

Adult (other than those above) authorized to pick up child:

Phone: Cell:

Emergency Contact (other than those above):

Phone: Cell:

 

Special Needs

Medical Information (allergies, medications, diet restrictions):
This information is confidential and will not be shared with anyone other than your child's camp instructor.

Learning or behavior needs (learning disabilities, behavior issues that may affect group learning):
This information is critical in ensuring the very best experience for your child.

 

Payment Due
You may pay with a check by mail to the address listed below or pay by card in person or over the phone.

$50 per child
$40 per child for MNCH members (members receive discounts on programs throughout the year including summer camps, family days and no-school day programs, as well as free admission to exhibits all year).

*After care is available until 5:15 p.m. for an additional $10

 

Your registration is not finished until you complete the steps below:

In addition to filling out and submitting the form above, you will need to download, sign, and submit a Release of Liability and Emergency Medical Care and a Media Authorization.

You may either mail or drop off the permission form with your payment to 1680 East 15th Ave., Eugene, OR 97403-1224.

Questions or payment by phone at 541-346-3116 or in person, 9 a.m.-5 p.m. Monday through Friday