This document is a registration form for Calypso Farm's summer gardening camp for teens. It requests information about the child, including name, age, school, and contact information for parents. It asks the applicant to choose which session they want, dates they may miss, and preferred school location. There are options to pay the $300 fee by check, credit card, or apply for a partial or full scholarship based on family income.

1. Summer Gardening Camp Registration
Calypso Farm’s Engaging Alaskan Teens in Gardening (EATinG)
Child Information
Child Name (First and Last):
Age: School: Current Grade Level:
Mailing Address:
City: State: Zip Code:
Parent / Guardian Information
Name: E-mail:
Home Phone: Cell Phone: Work Phone:
Mailing Address (if different from applicant’s):
Choose a Session:
______ Session 1— June 3– July 3 ______ Session 2—July 15– August 15
My child is available for all camp days
My child will miss these days:
Choose the school where you would like to participate:
You do not have to attend the school to register. If you are able to participate at multiple schools, please rank
your selections.
____ Chinook Charter School ____Hunter ____Pearl Creek ____Randy Smith
Program Fee
____ I am including a check for $300 ____Call me for my credit card information
____ I am applying for a scholarship (complete the information below)
Program Scholarship:
Your individual yearly income before deductions for taxes and social security (include child support)?
$0- $15,000 $15,000-25,000 $25,000- $35,000 $35,000-$50,000 $50,001 +
For my child to participate in the program, I can contribute:
$250 $200 $150 Other: $__________ I’m requesting a full scholarship
1) mail this form to Calypso, PO Box 106, Ester AK 99725
2) 2) call Calypso at 451-0691
TO RESERVE YOUR SPOT: