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
Country Postal Code

School Phone
School Fax

Principal Name

Principal Email

Teacher Home Address

City State
Country Postal Code

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

Discover the California Backcountry

Explore GIS Mapping

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

Single Camp Internet Classroom year round subscription including
the Tool Kit for $299

Tool Kit Options (one per kit included)
Digital Camera          Video Camera 

Additional groups of students, per 35, same teacher, $100 per group:
Qty of groups

3-day Training Workshop for one teacher for professional development $350 - $375
(Email Us For More Information)

Additional Tools

GPS $120         Video Camera $120       Digital Camera $120 

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