ScienceWiz Summer Camp 2008 Enrollment Form

Date __________ I give my permission for my child to attend the ScienceWiz Summer Camp
Camper's Name__________________________________________________
Birth Date_______________ Entering Grade______________
Home Phone__________________ Work Phone________________________
Address_________________________________________________________
________________________________________________________________
City________________________________ State______ Zip_______________
e-mail:___________________________________________________________

Select the Camp Week(s) that will work for you:

q June 16-20 Robotics Camp at Berkeley. Half Day $275 Full Day $390
q June 23-27 Robotics Camp at Berkeley. Half Day $275 Full Day $390

q July 7-11 Electric Car Camp at Berkeley. Half Day $300 Full Day $420
q July 14-18 Electric Car Camp at Berkeley. Half Day $300 Full Day $420
q July 21-25 Solar Car Camp at Berkeley. Half Day $350 Full Day $490

Select the camp times that work best:
q Morning (8:30am-12:30pm)
q Afternoon (1:00pm-5:00pm)
q Full Day (8:30am-5:00pm)

10% Discount for payment before March 31, 2008
Payment Amount Enclosed ________________________
Payment Method:

q Check
Make Checks Payable to: ScienceWiz
Mail: ScienceWiz/P.O. Box 20533/El Sobrante, CA 94820-0533

Credit Card: q Visa q Mastercard q Discover q American Express
Credit card #________________________________________Expiration Date________________

The parent (or guardian) acknowledges responsibility for class attendance and for picking up students promptly.
Parent Signature____________________________________
Print Name________________________________________

Phone: 510-222-2638 / Fax 510-223-6953
ScienceWiz / P.O. Box 20533/ El Sobrante, CA 94820-0533