SAT/ACT Registration

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.

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