Community Education

Youth Spring Break Mini Camp

WHEN: Spring Break (March 16 th

WHERE: Community ED Facility

Cafetorium

WHO: 1 st – 5 th Grade

Time:

9:00 a.m. – 11:00 a.m.

Cost: $100 (per session)

– 27 th ) Registration Now For more information log onto www.fusdaz.org Or please contact Community Education, [email protected]/480-987-5385 or 480-987-5386

REGISTER ONLINE:

https://payment.fusdaz.org

or submit registration below to: Community Education, P.O. Box 2850, Florence, AZ 85132

Student’s First Name Gender Home Address City, ST, Zip Grade Students School Age Mother’s Name Father’s Name Emergency Contact Emergency Contact # Permission to photograph?

Mother’s Cell Father’s Cell How will your child get home?

Authorized to pick up?

Email Address Special Care?

I give permission for my child to participate in the sports program listed. I/we understand all risks and hazards incidental to such participation and do hereby waive, release, absolve, indemnify and hold harmless Florence Unified School District and the school from any claim arising out of any injury to my child.

Parent Signature:_________________________________ I give permission to photograph my child during camp participation for publicity use and/or news release. YES NO Does your child have health conditions/concerns of which staff should be aware? If so, please explain: PAYMENT: Register online at https://payment.fusdaz.org

For online payment questions call (480) 987-5386. For camp related questions, contact the coach listed above.

For office use only: Item #