GO FISH! and Virginia Stream Team Registration

GO FISH! and Virginia Stream Team Registration

Form

Contact Information

Parent/guardian’s name:______Child’s name :______

Address:______City:______State:______Zip______

Phone (______)______Work Phone (_____) ______Cell Phone (______)______

e-mail address: ______

School name______2018/2019 grade______

Class Choice Information

Please indicate all class sessions you would like to attend

Cost: Go Fish: $330.00 per week-long class, Stream Team: $300.00 per class***

Virginia Stream Team (rising 6 th-9 thgraders), July 16-20, 2018: 

GO FISH! Session 1 (rising 6 th-9 thgraders), July 23-27, 2018: 

GO FISH! Session 2 (rising 6 th-9 thgraders), July 30- Aug 3, 2018: 

***We offer a limited number of need-based scholarships on a first-come, first-serve basis. To apply for a scholarship, please

contact Dave Hopler at or (804) 827-0236.

Payment Information

Total Amount Due:

PAYMENT REQUIREMENTS: For non-scholarship students, we require at least a $100 deposit (check or money order) with this

completed registration form. The remaining balance (payable via check, money order or cash) will be required the first day of

the workshop. Deposits are non-refundable after June 1, 2018.

Would you like to apply for a need-based scholarship? Yes No 

Payment included: Paid in full Deposit Deposit Amount ______

Checks made payable to: VCU

Emergency Information and permission to attend

Are there medical conditions that we should know about in connection with the student’s participation in these courses (e.g.

allergies, asthma, ADHD)? If yes, please explain______

Please list any medications that the student will need to take or carry with them during the course:

______

Emergency contact - please list at least one person who can be contacted at all times in case of

emergency

Name: ______Phone:______Relationship to child______

My child has permission to attend the above-indicated course(s). I understand that any personal injury claims must be covered

by my own insurance. I give permission for my child to participate in field trips and in all class activities, to be video- taped,

photographed and interviewed, and to have samples of my child’s work displayed.

Parent/guardian’s signature:______

To register, e-mail this completed form to: or mail to:

ATTN: Rice Rivers Center Summer Camp

VCU Life Sciences

PO Box 842030, Richmond, VA 23284

GO FISH! and Virginia Stream Team Registration

Form

For more information, contact David Hopler at: (804) 827-0236 or e-mail: