Elementary Institute of Science (EIS) Registration Form

EIS Logo
SPRING CAMP 2019 (Grades 2 - 8)

MON/March 25 - WED/March 29
Hours: 9:00am - 4:00pm
Theme: Water Warriors
Price: $200/student*

*Sibling discount available and will be automatically applied

Before/After Care for Spring Camp Available! Information releasing soon.

NEW: Registration now includes participation information and waiver of liability.

PARENT/GUARDIAN INFORMATION












This program is located in San Diego, CA ONLY
SCHOLARSHIP REQUEST
Scholarship application period has closed on Monday, March 11, 2019 at 11:59PM. Applicants will be notified of their status by Friday, March 15, 2019.


We encourage you to check our website regularly for future scholarship opportunities.

SCHOLARSHIP REQUEST
SCHOLARSHIP APPLICATION



$
STUDENTS

STUDENT 1



MM/DD/YYYY




STUDENT 2



MM/DD/YYYY




STUDENT 3



MM/DD/YYYY




STUDENT 4



MM/DD/YYYY




STUDENT 5



MM/DD/YYYY




 
AUTHORIZED ADULTS FOR PICK-UPS
Please provide the authorized adult(s) first name, last name, and phone number.






TEMPORARY MEDICAL AUTHORIZATION
By enrolling my child(ren) to attend Spring Camp 2019 at the Elementary Institute of Science (EIS), I, the parent/guardian, give EIS permission to act on my behalf in case of a medical emergency for my child(ren) while participating in the program.
EMERGENCY CONTACTS






MEDICAL INFORMATION





MEDIA RELEASE
By enrolling my child(ren) in Spring Camp 2019 with the Elementary Institute of Science (EIS), I, the parent/guardian, authorize EIS to photograph, videotape, film, or quote my child(ren).

I authorize the Elementary Institute of Science (EIS) to permit the use and the publication of any photographs, videotape, or film of my child(ren) for publicity purposes, including release of such photographs, videotape, film or quotes, to the news media and on the EIS website. I agree to hold harmless the Elementary Institute of Science, its officers, agents, and employees from any liability resulting from, or arising in connection with, the taking, publication, and release of the photographs, videotape, film or quotes of the student(s) in this agreement.
 
DONATION (OPTIONAL)
REGISTRATION SUBTOTAL
$
SCHOLARSHIP APPLICATION FEE
$
This amount will be refunded if your student(s) are not awarded a scholarship.
TOTAL PRICE
$
IMPORTANT PROGRAM INFORMATION
Cancellation Policy
Cancellation and refund will be issued based on when EIS is notified of cancellation, prior to start date.
  • 1 month or more = Registration fee minus $20 processing fee
  • Less than 1 month prior to program start date = 50% refund
  • Less than 2 weeks prior to program start date = 25% refund
  • Less than 1 week prior to program start date = No Refund

By enrolling my child(ren) in this program, I hereby give permission for them to participate in all the various activities, including field trips, of the Elementary Institute of Science (EIS). EIS does not assume financial or legal liability in case of injury or accident. I hereby waive all claims against the Elementary Institute of Science, its Board, employees, and volunteers for injury, accident, illness or death occurrence while participating in EIS programs.
CREDIT CARD





Comments/Notes for EIS (Optional)

(HIDDEN FIELDS)