Camp Internet Classroom
Subscription Form



Teacher Contact Information

Name

Email


School Contact Information

School Name

Grade(s) you teach

Number of students

School County

School District

School Address

City State
Zip

School Phone
School Fax

Principal Name

Principal Email

Teacher Home Address

City State
Zip

Home Phone

Home fax

I am enrolling in the following Camp Internet Online Expeditions:

Discover the California Channel Islands

Explore the Ancient Southwest

Resdicover America's Original Promise - American History

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

Discover the California Backcountry

Explore GIS Mapping ( basic GPS/GIS resources are available to all grades
- this track selection is for a higher ed version for 7-12 graders)

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

Single Camp Internet Classroom year round subscription
$295 (required of every participant)

Core Materials Kit with teacher and student (35) supplies and GPS unit - $250

3-day Training Workshop for one teacher for professional development $350

Teacher Training:

Total cost of services / products ordered :

Payment Method

I am submitting a purchase order

Agency issuing PO:

Contact for PO - Name
Phone Fax
PO#
PO#
PO#




The following is for teachers subscribing individually, rather than through a district or school Purchase Order:

I will be paying by credit card MC Visa Am Ex
In Full - or - Monthly over 12 months

Card #
Exp Date
Card Holders Name
Card Holders Address

I will be paying by check

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