Dennis Humphrey
408 Wildwood Drive
Edgewater, Florida 32132
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Student's Name_______________________________________________

Parent/Guardian's Name________________________________________

Address ____________________________________________________

____________________________________________________

Email address ________________________________________

Phone: (day)____________________ (evening)_____________________

Student's Age________  Current Grade__________     Boy   Girl    (circle)

School ___________________________________________

Will your child need extended care, 3:30pm - 5:00pm? ($20/week) Yes____No____

Tuition: $150 per student for the week. This includes all materials and two daily snacks. Each student will need to bring their own lunch and drink daily.

Once registered, about 1-2 weeks prior to camp, you will receive a packet with daily itinerary, directions to camp, and parent consent form. Please feel free to contact us with any questions at: (386) 428-2670 or info@floridasciencecamp.com