English Form Efec Summer School

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The   E ducation   F oundation   o f   E agle   C ounty  
Summer   S chool   o f   R ock   R egistration
 
Please   c omplete   t he   f ollowing   i nformation   f or   y our   c hild   t o   b e   e nrolled  
in   S ummer   S chool   o f   R ock   D ay   C amp  
Little   B each   A mphitheater,   M inturn,   C olorado  
August   8   -­‐ August   1 2,   2 016   9 -­‐3:30   d aily  
1. Student   N ame:    
 
 
 
 
 
 
 
 
 
 
 
 
 
2. Mailing   A ddress:      
 
 
 
 
 
 
 
 
 
 
 
 
3. Physical   A ddress:        
 
 
 
 
 
 
 
 
 
 
 
 
4. Date   o f   b irth:      
 
 
 
 
 
 
 
 
 
 
 
 
 
5. Gender:  
   
M      
F  
 
6. School   N ame:      
 
 
 
 
 
 
 
 
 
 
 
 
 
7. 2016/2017   g rade   i n   s chool:      
 
 
 
 
 
 
 
 
 
 
 
8. Please   d escribe   a ny   a llergies,   p hysical   d isabilities,   l earning   d isabilities,   a nd/or   p hysical,   m ental,  
psychological   c hallenges:  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Parent/Guardian   I nformation  
 
9. Name:      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
10. Relationship:      
 
 
 
 
 
 
 
 
 
 
 
 
 
11. Primary   p hone:    
 
 
 
 
Cell   p hone:      
 
 
 
 
 
 
12. E-­‐mail   a ddress:        
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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