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 - Throwing Machines | June 28 - July 2
Week 2 - Imagineering | July 12 - July 16
Week 3 - Rocketry & Flight | July 26 - July 30
Week 4 - Strongest Bridges | August 9 - August 13



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