OPERATION JUNK REGISTRATION

Please fill out the form below and click 'Continue'. Red indicates required fields.

Participant:

Birthdate:

Age:

Grade:

Any medical conditions/allergies?
If yes, please explain.

 Yes No

Parent's/Guardian Name(s):

Address:

City:

State:

Zip:

Home Phone:

Cell Phone/Work Phone #1:
Name:

Cell Phone/Work Phone #2:
Name:

Emergency Phone Number:
Name:

Authorized person to pick-up participant:
Phone Number:

Comments:

Choose week(s) of participation:

Week 1 - Blast Off | July 9 - July 13
Week 2 - Kitchen Chemistry | July 16 - July 20
Week 3 - Customized Cars | July 23 - July 27
Week 4 - Build It Yourself | July 30 - August 3
Week 5 - Rocketry & Flight | August 6 - August 10



©2000 - 2008 Murray Educational Services, Inc., Ellicott City MD 21041 All Rights Reserved. Some clip art images courtesy of Discovery Education.