Please complete a registration form for each student. A parent/guardian must bring the student to the first day of camp to complete the registration process. Camp fee is $10/per week per student.

For financial assistance, please contact your child's campus office prior to May 25, 2017.

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* 1. Student Last Name:

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* 2. Student First Name:

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* 3. Student Grade Level 2018-2019

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* 4. Parent/Guardian Name:

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* 5. Parent/Guardian Phone:

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* 6. Parent/Guardian Email:

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* 7. June 3-6  ELEMENTARY CAMPUS unless otherwise noted (8:30-11:30AM)

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* 8. July 22-25 High School Gym

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* 9. By providing my initials below and my signature at registration, I authorize my child's participation in the Coahoma ISD Summer Enrichment Program.  I further release Coahoma ISD, its employees and agents, from any and all liability claims and responsibility for injury or property loss. 

I also provide authorization for Coahoma ISD to seek emergency medical care as needed for my child during camp activities.

Please place initials in box below; you will be asked to complete signature at registration.

Signature: __________________________________________________(at on-site registration)

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