Somerville Schools Technology Camp 2017 DigiVILLE



Are you interested in learning to code? Do you enjoy building digital games, apps, or robots? Does creating stop motion videos or digital art interest you? Have you thought about launching your own YouTube channel? If so, sign up for DigiVille and learn all things technology! th Dates: July 5 -July 27th Monday-Thursday Location: Somerville Middle School Time: 8:30-11:30 Cost: $200.00

Program cost will not be pro-rated. Check or money order payable to: Somerville Board of Education Financial assistance is available for students who demonstrate need. For information please call: (908) 218-4118 This program is open to all Somerville students going into grades 1-8. Enrollment is limited and is on a first come, first served basis. All forms enclosed must be returned to be considered for enrollment. Please return payment along with the attached registration, emergency, and medical forms no later than Friday, May 12, 2017 to: Somerville Board of Education c/o Mrs. Valentina Carleo 51 W. Cliff Street Somerville, NJ 08876 Please Note: Students may not participate in more than one summer program within the school district.





TECHNOLOGY CAMP (2017) GRADES 1-8 EMERGENCY FORM Dear Parent/Guardian: Please complete, by printing in ink, the information requested below so that we may better serve your child should an emergency arise.

PARENT/GUARDIAN INFORMATION Student: ________________________________ Date of Birth: _________ Grade (in September 2017): ______ Student’s Home Address: __________________________________ Town: _____________________________ Student T-Shirt Size: _________________________________________________________________________ Mother/Guardian Name: Place of Work/Address: _________________________________

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Home Address:

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Hours of Work: ______________________ Return: ____________

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Work Telephone:

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Home Telephone: _________________________________ Father/Guardian Name:

Place of Work/Address:

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Home Address:

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Hours of Work: ______________________ Return: _____________

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Work Telephone:

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Home Telephone: _________________________________



EMERGENCY INFORMATION: Names of two persons willing to arrange for transportation and care of your child if you cannot be reached. Please inform person(s) of this. Name

Telephone

1. 2. Doctor to notify in case of emergency:



Address



My child will be going home: (Please check and complete) □ walking with _______________________________________________________ □ ride with __________________________________________________________ □ Other (please specify) ________________________________ (parents MUST make own arrangement Parent/Guardian Signature _____________________________________



Date ___________________

MEDICAL FORM Please print or type using ink. All information will be kept confidential. Student: _________________________ Grade (in September 2017): _____ Last name

First name

1. Is your child allergic to bee/wasp stings? Yes ___ No ___ If yes, please list treatment.

2. Does your child have any allergies that would affect him/her at the program? Yes ___ No___ If yes, please list allergy and treatment.

3. Does your child have any medical condition(s), such as asthma, seizures, etc.? Yes ___ No___ If yes, please list condition(s), symptoms, and treatment.

4. Will your child need to receive medication during program hours? Yes ___ No___ If yes, please list medication(s) below.

Please supply your child’s medication in the actual prescription container/bottle, which should include your child’s full name and dosage information. 5. Date of last tetanus shot: _______________________

________________________________________________________ ________________________ Parent/Guardian Signature Date Medication(s):



Office use only: Date received: __________________ Check # ___________________