Camp Internet & free DSL Subscription Form


Parent Contact Information

Name

Email


Country

Address

City State
Zip

Phone
Fax

If a Gift list Name:

I understand that my Camp Internet Subscription includes complete access to all classrooms including the following Camp Internet Online Expeditions:

Discover the California Channel Islands

Explore the Ancient Southwest

American History

Explore the Global Garden

Discover the California Backcountry

Explore GIS & GPS Mapping

Services Ordered
I am ordering the following services :

Single Camp Internet Classroom year round subscription including
the Classroom Supplies for $35.00 month


Would you like to give a subscription to your child's school class?
$250 for an entire year for a full class of 35 students and their teacher.

Additional groups of students, per 35, including teacher, $250 per group:
Qty of groups

Total cost of Subscriptions ordered :

Payment Method


I will be paying by credit card MC Visa Am Ex
In Full
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
PO Box 325
Buellton, CA. 93427
(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 rain@rain.org