Enroll
Note:
Please contact us prior to completing enrollment form for sibling or multiple week discounts.
Course Information
Course:
Choose One
Build 'Em, Bust 'Em
Mission Impossible
Rippin' Rockets
Storm Chasers
Flyin' High
NC Treasure Hunt
Rock It Racers
Spin It
Lev'Er Right Here
Special Camp
Date of course: (mm/dd/yy)
See our calendar
Course:
Choose One
Build 'Em, Bust 'Em
Mission Impossible
Rippin' Rockets
Storm Chasers
Flyin' High
NC Treasure Hunt
Rock It Racers
Spin It
Lev'Er Right Here
Special Camp
Date of course: (mm/dd/yy)
See our calendar
Course:
Choose One
Build 'Em, Bust 'Em
Mission Impossible
Rippin' Rockets
Storm Chasers
Flyin' High
NC Treasure Hunt
Rock It Racers
Spin It
Lev'Er Right Here
Special Camp
Date of course: (mm/dd/yy)
See our calendar
Scientist Information
First Name:
Last Name:
Nick Name:
Gender:
Female
Male
Grade Level:
3
4
5
6
7
8
School:
Date of Birth:
(mm/dd/yyyy)
Parent/Guardian Information
First Name:
Last Name:
First Name:
Last Name:
Address:
City:
State:
Zip:
Phone: (
)
-
Cell Phone: (
)
-
Email:
Emergency Contact Information
Name:
Relationship:
Phone: (
)
-
Medical Information
The programs offered by Rock It Learning involve many hands-on crafts and some field trips to local sites. In order to provide the best possible handling of any incidents, we need the following information. This information is strictly confidential and will be handled as such.
Doctor:
Phone: (
)
-
Dentist:
Phone: (
)
-
Insurer:
Policy Number:
Allergies (type):
Medications:
Any medical condition or ailment, whether physical or mental, diagnosed or undiagnosed, that could hinder child’s involvement in any camp activity?
Other Information
Who may pick up your child:
Other notes and special instructions:
Shirt size:
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
I agree to the following forms, policies, and agreements, and certify that the medical information provided is accurate:
The Liability Release Acknowlegement and Assumption of Risk Form
The General Policies and Releases Form
* Note: Parents must come in the first day they drop their children off in order to sign a paper copy of the above forms.
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