For questions or to register
contact:
Melissa Luttenbacher
618-634-3266 melis
s
al@shawneecc.edu
SUMMER WORKSHOP 2020 REGISTRATION FORM
IMPORTANT: All workshops are virtual. Please contact us if you have any questions. Please place an
" X" in the selection box for
your choices.
Parent' s Last Name:
Child's Las
t Name:
County:
Parent's First Name:
Child's First Name:
Stre et Address:
Phone:
School:
SSN:
Date of Birth:
P
ARTICIPATION AGREEMENT AND PRESS RELEASE: As a participant in this program, I understand that all workshops are virtual and will be
conducted on-line. I certify that all the information that I have provided on this application is complete and accurate to the best of my knowledge
and I agree to observe all of the rules and regulations of the institution at which I am enrolled.
Photo Release - I understand that Shawnee Community College may photograph my child during SAINTS' KIDS CAMP and that these
photos may appear in newspapers, pamphlets and on the Shawnee Community College Website for promotional and informative purposes.
I
giv
e consent for my child to be photographed
for this purpose.
Parent / Guardian Signature:
I do not give my co
nsent for my child to be photographed.
Email:
Camp/Activity
Date
Time
Age
Fee
X
Katie Hook Art
Workshop I
July 29
10:00 a.m. - 10:45 a.m.
Ages 6 - 12
Katie Hook Art
Worksh
op II
July 29
8:30 a.m. - 4:00 p.m.
Grades 7 - 12
E.L.I.T.E. Entrepreneur Camp
July 20 - 23
8:30 a.m. - 4:00 p.m.
Grades 7 - 9 $10
Mario Kart
Tournament
July 27
Cell Phone
Photography
July 28 - 30 10:00 a.m. - 10:45 a.m.
Grades 7 - 9
Please make checks for any fees payable to Shawnee Community College and must accompany the registration form
Email or mail completed registration form to: Shawnee Community College, 8364 Shawnee College RoadUllin, IL 62992, ATTN: Bursar's Office
PRIZES!
State:
City:
11:30 a.m. - 12:15 p.m.
Ages 6 - 12
Free
Free
Free
Free
Race/Ethnicity*
Gender*
*This information is for demographic purposes only
Choose not to disclose
Choose not to disclose
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