Emerald Coast Science Center
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2010 Summer Camp Registration

Important: We do not currently accept credit cards online. We will call you within two business days for your credit card information. Please provide a telephone number where you can be reached during the day.

Please complete a separate registration form for each student.

REGISTRATION DEADLINE
The ECSC must receive a completed registration form and full payment by 4:00 PM on the Friday before the class.

CONFIRMATION
All applications will receive a confirmation letter upon receipt of completed registration form and payment.

 

 
Parent's Name:
Child's Name:
Child's Age:
Phone:
Email:
Street Address:
City, State, Zip:
First Class Code:

Click Here To Open The Class Code List

Second Class Code:
Third Class Code:
Emergency Contact:
Emergency Contact Phone:
Approved Pick-up List & Relationship:


Information provided is confidential.  See our privacy statement for details.
Emerald Coast Science Center