Registration Form

This form will be accepted throughMay 25, 2012.

Tuition for each AIG Summer Enrichment Program is provided through Iredell-Statesville Schools. There is a $15.00 non-refundable registration fee for one course and a $25.00 fee for two courses taken by the same student. Please make checks payable to Iredell-Statesville Schools. Check the programs for which you would like to register and return registration information and fee to:

AIG Summer Programs 2012

ADR Education Center

410 Garfield Street

Statesville, NC 28677

Please note: The specified grade levels for each session refer to those assigned for the 2012-2013 school year.

Student Name: ______Parent Name: ______

Grade completed June 2012: ______Current School: ______

Home Phone: ______Other Phone: ______*Email: ______

(** Confirmation for camps and all other camp communication will be done through email.)

Please note that if there are not enough students enrolled in a particular course, it may be canceled. We will notify you if that occurs. Camp registration is first come-first served.

____iMovie FilmCamp (Grades 6-9) Session 1

___Geocaching (Grades 5-9) Session 2

___Advanced Robotics (Grades 5-12) Session 3

___Beginning Robotics (Grades 3-8) Session 4

___Advanced Robotics (Grades 5-12) Session 5

___Beginning Robotics (Grades 3-8) Session 6

___Theater Arts (Grades 4-6) Session 7

___Theater Arts (Grades 7-12) Session 8

___Rock On! (Grades 4-5) Session 9

___The Science Spectacular (Grades 3-6; Girls Only) Session 10

___The Science Spectacular (Grades 3-6; Co-Ed) Session 11

___Beginning Robotics (Grades 3-8) Session 12

___Intro to Chess (Grades 4-8) Session 13

___Advanced Chess (Grades 6-12) Session 14

___Odyssey of the Mind (Grades 6-9) Session 15

___Odyssey of the Mind (Grades 3-5) Session 16

___Advanced Video Camp (Grades 7-12) Session 17

Please review the following list carefully and sign below to indicate your acceptance:

  • Parents will provide transportation.
  • Staff will be responsible for students ONLY during program times. Please drop off and pick up on time. Students must be signed in and out by the parent/guardian.
  • Photographs including my child may be used for promotional purposes.
  • If my child is registered for a morning and afternoon program at the same site, parents will provide a bagged lunch and supervision during lunch.
  • I understand if I want my child to have a snack, I must provide it.

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Parent Signature Date