A registration fee of $45 for the purchase of t-shirts and education materials is required and can be paid on site during registration.
Name: ______________________________________________________ Sex: £ Male £ Female
Last First Middle Initial
Address: _____________________________________________________________________________
Number Street City State Zip Code
Telephone: ___________________ Alternate Number: __________________
Email Address: _________________________________________________
Date of Birth: _____/_____/_______ Place of Birth: ________________
Emergency Contact: ________________________________________________________
Name Relationship
Address: _____________________________________________________________________________
Number Street City State Zip Code
High School Classification: £ Freshman £ Sophomore £ Junior £ Senior
What are you interested in learning more about? _____________________________________________
____________________________________________________________________________________
What special talents and/or skills do you possess? ____________________________________________
____________________________________________________________________________________
Permission to Photograph: The American Institute for Resource and Human Development, Inc. requests permission to include your son/daughters photo in the annual newsletter:
£ Yes, my son’s/daughter’s photo may be used in the newsletter.
£ No, my son’s/daughter’s photo may not be used in the newsletter.
SAT/ACT Preparation Summer Camp will be held from June 4, 2014 to July 2, 2014 from 8:30 a.m. to 12:30 p.m. at Salem High School in Conyers, GA, Rockdale County.
_______________________________________ ___________________________________
Signature of Parent/Legal Guardian Printed Name of Parent/Guardian
This FREE Summer Camp is being brought to the community by the American Institute for Resource and Human Development, Inc., a non-profit, 501(c) 3 organization. Your donations are tax deductible.