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Santa Cruz Learning Center Spring Break Camp Registration 2023
Thanks for registering for the SCLC Spring Break Camp!
Location: 2560 Soquel Ave. Suite 201
Santa Cruz, CA 95062
Dates: Tuesday 4/4, Wednesday 4/5, and Thursday 4/6
Times: 9:30am-4pm
$65 per day (all three days $180, $15 off)
Inquire with Jennifer with specific questions.
(734) 620-0660
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Student First Name
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Student Last Name
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Student Cell Number (if Applicable)
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Student Email Address (if applicable)
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Grade Level for the 2023 school year
*
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School(s) Attending
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Parent/Guardian 1 Full Name
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Guardian 1 Mailing Address
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number and Street, City, Zip
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Parent/Guardian 1 Email
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Parent/Guardian 1 Phone #
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Billing address for Parent/Guardian 1
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Street address, City, State, Zip
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Best way to contact Parent/Guardian 1
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Parent/Guardian 2 Full Name
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Guardian 2 Mailing Address
number and Street, City, Zip
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Parent/Guardian 2 Email
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Parent/Guardian 2 Phone #
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Best way to contact Parent/Guardian 2
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Has this student been diagnosed with any learning exceptionalities?
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no
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If your child has been diagnosed with a learning exceptionality, please share with us a little about his or her diagnosis. If possible, could you share their diagnosis report with our education team? Do you have specific tools and/or learning/teaching strategies that have been successful?
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Occasionally we take photos/videos during class. Do we have your permission to use photos/videos of your child in our newsletters and/or fliers to promote our classes?
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How did you hear about us?
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My Education Specialist/Education Consultant
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Web search
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SCLC Newsletter
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Is there anything else that we didn't ask on this form that you think we should know?
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You don't have to come to camp all three days. If you would like, you may come for 1, 2, or all of the days that we are offering camp.
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Please indicate which days you would like to come (click all that apply)
Tuesday
Wednesday
Thursday
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How do you plan to pay?
With a check on the first day of class.
Please send me an invoice, I will pay online.
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