Camp Internet District Application


We are enrolling in Camp Internet as:

New participants Returning Campers
And will be including:
Teachers Afterschool Program Leaders Librarians Technology/Lab Coordinators

We are enrolling Teachers in the following Camp Internet Online
Expedition Themes:

Qty Discover the California Channel Islands (suggested for grades 4-9)

Qty Explore the Ancient Southwest (suggested for grades 5-9)

Qty American History (suggested for grades 5-12)

Qty Global Garden Class (suggested for grades K-12)

Qty Discover the California Backcountry (suggested for grades 4-9)

Qty GPS & GIS Mapping Class(applicable all grades, higher level projects available                 for 4th-12th grades)

Services Ordered
We are ordering the following classroom subscriptions
1 Teacher, 1 Assistant Teacher and 35 Students per subscription:

I. We are enrolling teachers in the year round online program, with student activities and online professional development at the discount rate of $199 per Teacher & Class (minimum of 3 classess for discount):

 

Total - all services and Teacher Technology Skills Training combined: $

Contact Information

District Contact

District Contact's Work Email

Agency Name

Location - Street Address

City State Zip

Contact Phone Contact Fax

URL

Superintendent's Name

Superintendent's Email

Payment Method

I am submitting a purchase order/s for the district's enrollment ( you can provide one PO or seperate for program/materials/training)

Agency issuing PO:

Contact for PO - Name
Phone Fax
PO# PO# PO#
Address
City State Zip

Agreement

This enrollment agreement includes opportunties for live training for our teachers, online programs for students, and optional materials. By enrolling, I agree, on behalf of agency, to pay the program package costs, and will be responsible for any travel or field costs or liabilites. Our teachers and students will observe the Camp Internet Accpetable Use Policies for responsible online activities and we will participate fully to the best of our abilities.

Please print, then submit online, and then sign this application/mail a hard copy to
Camp Internet
P.O. Box 325
Buellton, CA. 93426
(if you decide later to make changes on this form, do so by hand and send in with signature)

Once the district application is submitted, please have each participating teacher use the individual enrollment form to register.


Signature
Date
Thanks for Enrolling !
Questions? Call 1-800-889-2823, or email rain@rain.org