KOC 2016 Camp Selection Form - Butler County Community College

KOC 2016 Camp Selection Form - Butler County Community College

KOC 2016 Camp Selection Form
c Before Care (7:00 a.m. to 9:00 a.m.)
c After Care (4:00 p.m. to 5:30 p.m.)
KOC Summer Special Education
Week 6: August 1-4
c Lego Robotics 050168-28800
c Extreme Crafts 050172-28801 c Chef Is In Again 050281-28802
10:00 a.m. to 2:30 p.m
c June 20-23 050301-28871
c June 27-30 050301-28873
Kinder Camp: Kindergarten & Grade 1
9:00 a.m. to 12:00 p.m.
c Both Before Care & After Care
Grades 5 - 8
1:00 p.m. to 4:00 p.m.
Week 1: June 20-23
9:00 a.m. to 12:00 p.m.
Week 2: June 27-30
c Chess Club 050284-28810
c Spike It 050054-28812
c Paper Mache 050156-28816
c Robotics I 050094-28817
c Treasure Island 050263-28745
c Colorific 050264-28746
c Kinderplay 050127-28751
c Kinderplay 050127-28752
c Kinderplay 050127-28753
c Cookie Gourmet 050287-28827
c Dodge Ball 050190-28826
c Alice 1.0 050039-28835
c KOC Cupcakes 050152-28877
c Invention Convention
c Robotics I 050094-28822
050286-28824
c Ultimate Frisbee 050057-28825 c Kinderplay 050127-28754
Week 5: July 25-28
c Fit-N-Fun 050267-28750
c Kinderplay 050127-28755
Week 3: July 11-14
Grades 2 - 4
9:00 a.m. to 12:00 p.m.
c Robotics II 050055-28837
c Scrapbooking 050216-28831
c One Acts 050184-28832 c Amusement Park Engineers
050059-28833
1:00 p.m. to 4:00 p.m.
Week 1: June 20-23
c Food Science 050214-28758
c Soccer 050037-28759
c Cheer Camp 050123-28760
c Scratch 050268-28761
c Stop Motion Mania
050034-28762
c Simple Machines 050024-28763
Week
c Painting 050117-28764
c Presidential Expose
c Be Our Guest 050269-28765
050288-28828 c Total Gym 050249-28838
Week 2: June 27-30
c DIY 050180-28839
c Scrapbooking 050216-28766
c Act One 050033-28769
c Hunger Games 050290-28840
c LEGO Builders 050215-28767
c Bridges and Boats
050271-28770
Week
c Whiz Kids Science 050270-28768 c Mad Hops Jr. 050220-28771
c Field Ecology 050293-28845
c Dodge & Kick 050041-28775
c KOC Live 050176-28776
c Water Wars 050274-28777
Week 4: July 18-21
c Popsicle Stick Studio
050302-28890
c Scratch 050268-28779
c No Bake Yummies 050275-28780 c Punt! Pass! Kick! 050276-28782
c
c
c
c
Lego Robotics 050168-28790
Chef Is In 050032-28793
Flag Football 050013-28794
Eric Carle Art 050278-28795
c Outdoor Adventures
050279-28797
c Cookie-Palooza Jr.
050218-28798
c Sculptastic 050280-28799
www.bc3.edu/koc 4: July 18-21
c Mad Hops 050237-28841
c Cooking With Chef Mitch 050291-28842
c Geocaching 050292-28843
5: July 25-28
c Architectural Design
050071-28823
c Basketball 050153-28848
c Accessorize DIY 050295-28849
Week 6: August 1-4
c Makeover Madness Jr.
050277-28783
c Swish! 050120-28784
c Treasure Island 050263-28785
Week 5: July 25-28
c Alice 2.0 050066-28844
c Pre-Algebra 050140-28834 c Bedroom Makeover
050296-28853
c Sleepover DIY 050294-28846
c Twenty-Shot Movies 050243-28847
Week 3: July 11-14
c Super Gym 050119-28772
c DIY Sewing 050272-28773
c MORE Whiz Kids Science
050273-28774
c War Zone 050285-28818
c Hip Hop 050051-28819
c Photography Workshop
050226-28820
c Alice 1.0 050039-28821
Week 2: June 27-30
Week 4: July 18-21
c Arctic Adventures 050266-28749
1:00 p.m. to 4:00 p.m.
Week 1: June 20-23
Week 3: July 11-14
c Water World 050265-28747
c Nothing But Games
050036-28803
c Jump Jive Jam 050015-28804
c Delicious Desserts
050282-28806
c Space Camp 050283-28807
c Intro to Running
050232-28851
c Bridge Builders 050233-28852
c Paint Party 050289-28836 c Game On 050063-28854
c Intro to Web Design
050297-28855
c Letter Designs
050298-28856
Teens On Campus: Grades 6 - 12
c
c
c
c
c
c
c
Hip Hop Poets 050299-28857
DIY Holiday Décor 050300-28858
SAT Prep 050137-28870
Web Design 050142-28859
Fondant Cakes 050205-28860
Portrait Drawing 050259-28861
Inspired Delights 050144-28862
13 c
c
c
c
c
c
c
Robotics 050203-28863
Algebra Prep 050200-28864 Intro Photography 050148-28865
Geometry Prep 050201-28866
Summer Painting 050199-28867
Movie Makers 050195-28868
Creative Writing 050088-28869
724-284-8504
KOC 2016 Registration Form
Child’s Name: ____________________________________________________________________
2016 KOC T-Shirt - $14 each
Address: ______________________________________________________________________
Indicate the number of shirts you want
beside the size you want below.
City/State/Zip: __________________________________________ Date of birth: ____________
Child Size:
S ___
M ___ L ___
Name of Parent or Legal Guardian: __________________________________________________
Adult Size: S ___
M ___ L ___
XL ___ XXL ___
Home Phone: _________________________ Work Phone (Parent): _________________________
Email Address: ___________________________________________________________________
No. Shirts ____ x $14 = $ ______
School: ______________________________________________ Grade (as of Fall 2016): _______
In Case of Emergency Contact: ______________________________ Phone: _________________
Total Cost:
$ _______
Tuition and fee payment must accompany registration.
Before and/or After
Care Total:
$ _______
T-Shirt Total:
$ _______
$2 Registration Fee:
$ _______
c Attached is my check/money order made payable to BC3.
Please charge my:
c VISA
c MasterCard
c Discover
c American Express
Card No. ____________________________________ CVC # _______ Exp. Date: ____________
By my signature below, and as the parent/guardian of ______________________________________ ,
I agree to indemnify and hold harmless Butler County Community College, its officers, agents, and
employees for any loss or injury that my child may sustain while participating in the Kids on Campus
program. In case of emergency, I ask Butler County Community College to contact me or the authorized
adult listed above. If the College is unable to reach me or the authorized person named above, I authorize
Butler County Community College to secure emergency treatment for my child. I also understand that
disruptive and inappropriate behavior will not be tolerated and will result in student’s dismissal.
___________________________________________________________ Date: _______________________ Parent/Guardian’s Authorized Signature
I give permission for my child to be photographed, interviewed and/or videotaped while attending KOC
classes for future promotional purposes with the understanding that there is no compensation given.
c Yes c No
You will be required to fill out the Kids On Campus Student Information Form before the child attends their first
camp. These are mailed out at the time of registration and can also be found online at bc3.edu/koc.
Emergency Information
Child’s Doctor: ____________________________________________ Phone: __________________________
Doctor’s Address: _________________________________________________________________________
Doctor’s Hospital Affiliation: ______________________ Address: __________________________________
Medical information: c None c Allergies (i.e. stings, diet) ____________________________________
Other: __________________________________________________________________________________
Please describe symptoms and precautions: ___________________________________________________
Any other medical information we should know: ________________________________________________
How/Where did you learn about Kids On Campus: ________________________________________________
www.bc3.edu/koc 14 Total Payment:
$
Return this Registration Form
and Camp Selection Form on
page 13 by mail or fax.
Tuition must be paid at time
of registration.
Register
BY MAIL:
Butler County Community College
ATTN: Kids on Campus
P.O. Box 1203, Butler, PA 16003-1203
Register
BY PHONE:
724-287-8711, ext. 8504
You will still need to mail or fax the
signed registration form.
Register
BY fax:
724-287-3460
724-284-8504