Camp Internet Teacher Application


I am enrolling in Camp Internet as a:

New participant Returning Camper
And am a:
Teacher Afterschool Program Leader Librarian Computer Lab Coordinator

I am enrolling in ONE of the following Camp Internet tracks:

Discover the California Channel Islands (suggested for grades 4-8)

Explore the Anceint Southwest (suggested for grades 5-9)

Resdicover America's Original Promise (suggested for grades 7-12)

Explore the Global Garden (suggested for grades K-12)

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

Services Ordered
I am ordering the following services and/or products:

(please note which of these you are ordering - even if under a group / district purchase order)

Single Camp Internet Teacher year round subscription w/online professional development $295

Core materials kit with teacher and individual student (35) supplies and GPS unit $250

With a (select one) GPS Digital Still Camera Digital Video Camera

Live 3-day training workshop for one teacher for professional development $350

Contact Information

Teacher/Project Leader's Name

Teacher/Project Leader's Work Email

School / Agency Name

Site Location - Street Address

City State Zip

Site Phone Site Fax

URL

Principal/Directors Name

Principal/Directors Email

Teacher/Project Leader's Home Address

City State Zip

Home Phone

Home fax

Social Security Number

I am also interested in particpiating in (select one or more, no addtl cost):

GPS/GIS mapping studies Earth Sciences Center

Western Art and Literature Digital Photography and Video

I am also ordering the following (tax and handling/shipping incl):

GPS unit/s $120 each
Digital Still Camera/s $120 each
Digital Video Camera/s $120 each
Other

Teacher Training:

Payment Method - enrollment and materials fees are due by July 5th unless other arrangements have been made.

(I am not filling in the payment information below because I am included in a purchase order from my:
school district afterschool site library)

I will be paying by credit card MC Visa Am Ex
Card #
Exp Date
Card Holders Name
Card Holders Address

I will be paying by check sending with signed application will follow signed application
Name
Address
City State Zip

Agreement

This enrollment agreement includes opportunties for training for myself, online programs for my students,and optional mateirals and/or live training. By enrolling, I agree, on behalf of my school or agency, to pay the program package costs, and will be responsible for any travel or field costs or liabilites. I and my 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
1129 State Street A7
Santa Barbara CA 93101
(if you decide later to make changes on this form, do so by hand and send in with signature)

Signature
Date
Thanks for Enrolling !
Questions? Call 1-800-889-2823, or email explore@campinternet.net