Come join us on an ART SAFARI where Adventure and Art play together!

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1 RT ome join us on an RT SFRI where dventure and rt play together! The Safari rt day camp will be held at the labama enter for the rts in beautiful downtown Decatur. This artistic environment provides opportunities for children ages 5 and up to travel deep into the jungle exploring famous artists, discovering their artwork, and experimenting with fun techniques. The camp will spark imagination, creativity, exploration, and individual expression. RT LESSONS & ROJETS, GES, STORIES, USI, OUTDOOR TIVITIES, & TONS OF SILES, LUGHS...! N U F nd all for ORE INFORTION! amps are limited to 15 participants, on a first-enrolled, first-served basis. ll supplies and snacks are included. TRESURE HUNTERS RINFOREST RNGERS (ages 8-11) (ages 5-7) ZON RTISTS (ages 12 and up) JUNE 8-11, 2015 JUNE 22-25, 2015 JULY 6-9, :00 am - 11:00 am $ LESE NOTE: 9:00 am - 11:30 am $ 9:00 am - 12:00 pm $ Enrollment is limited, so please register early. ayment must be made in full with registration. ll enrollments or cancellations must be transacted at least 2 weeks prior to camp session chosen. ancellations after this will be given no refunds.

2 HOW TO REGISTER T R by mail or in person omplete all 4 pages of the application package, (application, camper pick-up form, technology permission form, and emergency contact and medical information) for each camper. pplications will not be accepted without parent signature and date. Enclose payment (check or money order) with registration materials. ayment is due in full for session registered. ail these materials to: SFRI RT, c/o alhoun ommunity ollege O Box 2216, Decatur, L Or hand-deliver to labama enter for the rts 133 2ND venue NE, Decatur, L pplications will not be accepted by phone, nor can we hold spots by phone. amper will only be enrolled when all registration materials (application and payment) are received and if space is available. You will receive a confirmation if your camper is enrolled. REGISTRTION FEE/REFUND OLIY amp sessions are filled on a first-enrolled, first-served basis. please register early. Registration is subject to availability, but all enrollments or cancellations must be transacted at least 2 weeks prior to camp session chosen. ancellations after this will be given no refunds. 3. Enrollment is limited, so ayment must be made in full with registration.

3 RT labama enter for the rts 133 2nd venue NE, Decatur L LITION FOR DIRETIONS: lease print or type all answers. Your child will be enrolled after the completed application and payment are received and if space is available. You will receive a confirmation letter once the completed application is accepted. ll parts of the application must be completed in full and signed. ayment must be made in full for all sessions enrolled at time of registration. NE OF RENT(S): DDRESS:ITY: STTE: ZI: HONE: HOE WORK: (O) WORK: (DD) O S ELL: DD S ELL: EIL: I F R E N T S R E U N V I L B L E I N N E E R G E N Y, L E S E O N T T : (NE:) (RELTIONSHI TO ER::) (HONE:) NE of ER 1*: (amper s Last Name) (amper s First Name) (.I.) BIRTHDTE: / / GE: GRDE ( ): LE FELE NE of ER 2*: (amper s Last Name) (amper s First Name) (.I.) BIRTHDTE: / / GE: GRDE ( ): LE FELE NE of ER 3*: (amper s Last Name) (amper s First Name) (.I.) BIRTHDTE: / / GE: GRDE ( ): *lease complete the attached forms for each camper. LE FELE

4 T R ER IK-U FOR lease list parents/guardians as well as anyone who may be picking up your camper. The authorized individual may be asked for identification. ER NE: I authorize any of the persons and individuals listed below and/ or individuals listed as emergency contacts on the Health Form to pick up my child. RENT/GURDIN SIGNTURE: RENT/GURDIN WHO Y IK U ER: OTHER EOLE WHO Y IK U Y HILD: 1) 2) 3) SEIL NOTE: The following person is never authorized to pick up my child: NE:

5 RT TEHNOLOGY ERISSION FOR ELETRONI UBLITION OF STUDENT WORK/ITURES I understand that from time to time the school may wish to publish examples of student projects, photographs of students, and other work on the website, or other media. lease check one of the options below: y child s name, work and photographs may be published on any electronic media used by the college. y child s name, work and photographs may not be published on any electronic media used by the college. Student Legal Name: (print) arent Name: (print) arent Signature: Date:

6 EERGENY ONTT ND EDIL INFORTION FOR hild s Name Date of Birth arent/guardian s Name arent s/guardian s Name Sex F lternative Emergency ontacts rimary Emergency ontact Secondary Emergency ontact edical Information Hospital/linic reference hysician s Name Insurance ompany _ hone Number _ olicy Number llergies/special Health onsiderations I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency. arent/guardian s SIgnature _ Date I give permission for my child to go on walking field trips (ages 5 and up). I release alhoun ommunity ollege and individuals from liability in case of accident during activities related to Safari rt amp, as long as normal safety procedures have been taken. arent/guardian s SIgnature _ Date