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:

Email:

After class, student will...

 Be Picked-Up Go to Columbia Association aftercare program N/A

Authorized person to pick-up participant:
Phone Number:

Comments:

Please select the week(s) your child will be participating in:

Week 1 - Ecology Engineers | June 28 - July 2
Week 2 - Kitchen Chemistry 2 | July 5 - July 9
Week 3 - Imagineering | July 12 - July 16
Week 4 - Human Body | July 19 - July 23
Week 5 - Rocketry & Flight | July 26 - July 30
Week 6 - Prehistoric Walk | August 2 - August 6
Week 7 - Veterinary Science | August 9 - August 13
Week 8 - Fizz, Bang, Pop | August 16 - August 20



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