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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