Summer Enrichment Registration

Gayton Crossing Shopping Center

1324 Gaskins Road

Richmond, VA 23233

Monday through Friday at The Science Place 1:00-4:00 PM.

Summer Science Enrichment 2008 Registration

Name of Parent
Address: City: State: VA Zip:
Home Phone: Cell Phone:
E-mail Address:
Child’s (Children’s) Name (s):
Age: Date of Birth:
Allergies:
Check Session Date:	July 7-11	August 4-8
	July 14-18	August 11-15
	July 21-25	August 18-22
	July 28-August 1	August 25-29

Fee: $125 per child.

Additional children in the same family will receive a $25 price reduction.

$50. Deposit is required to hold your reservation. Payment in full must be received two days before the session begins. If you are using a credit card, your card will be charged the remainder of the fee two days before the session starts.

Credit Card: ____________________

Number:

Expiration

Date:

Mail or fax registration to corporate office:

The Science Place . 1145 Bellewood Square . Atlanta, GA 30338

Fax: (770) 350-9905