health & wellness what are ampullae of lorenzini? how do...

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#18 Magic or Math?? (Gr . 3-4) Have you ever wanted to be a magician? Do you want to astonish your friends and leave them speechless with your amazing tricks? We will get behind the scenes and find out the math behind some pretty neat tricks. But remember...a true magician never reveals his (or her) secrets! Katie Lacher, Instructor Science #19 The Wonderful World of Wacky Science (Gr . 3-5) Icy volcanoes, electric Pla-Doh©, and elephant toothpaste - all things YOU can experiment with and learn about in the Wonderful World of Wacky Science! You will experiment and create fun, easy science experiments that you can show off to your family and friends using common household items. The Wonderful World of Wacky Science is waiting for you! Becky Lentz, Instructor #20 Space Camp ( Gr. 4-6) Rockets, spaceships, and life on other planets - come, explore our solar system beyond Earth. We will explore how to create a spaceship; how to launch it on a rocket; and where it can go! How can you live in space? Where can you go? What do you need? It will be an exciting week of science and engineering learning about Space! Alexa Ramby, Instructor #21 Dream House Design! (Gr . 4-8) Acting as an architect, you will be designing your dream house! From making blueprints to interior design, you can let your mind run wild: the only barrier holding back your design is your own imagination! Time permitting, we will be making a 3D model of your house that you can take home. Tom Braddock, Instructor #22 Lotions, Potions, and Slime! (Gr . 3-5) Ooey-gooey fun abounds! Explore properties of matter and basic chemistry as we make fluffy slime, unicorn poop slime, magnetic slime, butter slime, and more. On top of that, well become our own bath and body store exploring and inventing lotion, lip balm, and bath bomb recipes. Come: join the messy magic! Ashley Reser, Instructor #23 Hook, Line, and Sinker! (Gr . 4-8) Do you love fishing? Do you want to catch the big one”? Then gear up and get outdoors! Become better equipped through science to be a successful angler! Let a professional in both education and fishing build your understanding of food webs, tackle selection, and map reading so you can be the best angler on the water! The class will end with a Pro Day on the lake! Ryan Kerns, Instructor #24 Up, Up, and Away (Gr. 3-6) Did you ever wonder how planes that weigh thousands of pounds can fly through the air with the greatest of ease? Then strap in and get ready to explore the skies with us! Become a test pilot for the planes you design and construct. Come away with an understanding of aviation terms along with several airplane designs you can continue to build at home! Kevin Penwell, Instructor #25 CSI Investigation (Gr . 3-4) How do investigators bring the bad guysto justice? They use science! Join us as we work side-by-side with real CSIs to apply science to crime scene investigations. If you like solving mysteries, this class is for you! Jana Core, Instructor Please make selection based on the grade student will enter in the fall. #10 Raised in a Barn? Yes, and Its Awesome! (Gr . 2-8) Did you have ever wonder what it would be like to be a farmer? Do all cows produce milk? How do you milk a cow? Why are some eggs brown and some eggs white? Where do the different cuts of meat come from? Does this affect their taste? In this class, students will learn about various aspects of agriculture. Students will work with livestock and learn how we prepare an animal for the fair along with basic animal care and animal handling. Please note: This class will occur at the fairgrounds. Lora James, Instructor Health & Wellness #11 Game On! (Gr . 3-8) What did kids do for fun before gaming? Before the internet? In Game On!”, youll join us in experiencing creative, active, and interactive games with simple, everyday objects! Well make fun indoor and outdoor games to play with friends, with family, or even by yourself. Join us, and get your game on! Nancy Forsythe and Kathy Dodson, Instructors #12 KidFit (Gr . 2-5) Do you LOVE burpees? Do you love to move? Then grab your water bottle and prepare for action! During KidFit, we will learn how FUNctional fitness and proper nutrition keep our bodies strong and healthy! Come, get your sweat on while having FUN! Lindy Martin, Instructor #13: Kid Fit and Nutrition (Gr . 2-8) Kid fit will focus on fundamental movements in crossfit and nutrition. If you need to move, like us, this is the class for you. We will being doing WODs, learning proper technique, and learning healthy eating habits. Art Caudill, Instructor Language Arts #14 American Girl Adventures (Gr . 2-6) Take an adventure with the original American Girl dolls. We will travel through time, learning about each girl and creating crafts of their era. Theres no need to journey alone, though: we welcome you to bring your own American Girl doll to join us for this fun-filled journey! Candi Bodey, Instructor #15 WPKO & WBLL Sportscaster Camp (Gr . 6-8) At the tenth annual Sportscaster Camp, you will become a celebrity! Learn how to call a baseball game on the radio. This week will include fun training, sports debates, and guest interview, plus YOU will get to be on the radio for a live baseball game and sports talk show. Chad Wilkinson, Instructor Math and Problem Solving #16 DIY Escape Room (Gr . 6-8) Can your quick thinking help you beat the clock, or will you wind up trapped? Use your brain in new ways during this exciting class! As we work together to design and run our own Escape Room, you will learn how to solve all sorts of locks, codes, and hidden messages. Don't know what an Escape Room is? Watch the first 90 seconds of this video: https://tinylink.net/oKJoj. For a secret message, rearrange the following letters: echo deaRly at green flag? Joanna Reser, Instructor #17 Straight Line Curves?! (Gr . 4-8) Do you like geometry? How about crafts? Join us this week as we learn how to use nothing but straight lines to make curved designs. We will learn how and why it works; build and practice our skills; create our own designs; and — by the end of the week — we will stitch a design with thread that can be hung up on your wall at home! Shannon Peterson, Instructor Art, Music & Drama #1 Make It, Take It, Creative Crafts (Gr. 2-3) Enjoy creating cool, new crafts during SEA! Activities include painting, sand art, creating slime, making Pla-Doh©, and tie-dying your own shirt. Roll up your sleeves, and get ready to get messy! Stacey Holycross, Instructor #2 Making Composing a Breeze (Gr. 5-8) Creating your own music can truly be a breeze! In this course, we will use web-based computer software to create mini masterpieces! Well learn how to create simple motifs, spoken word chants/cheers, a blues song, commercial jingles and more while learning basic music theory. Plus, well even have a new website where you can continue creating and editing music after class ends! Morissa Sweeney, Instructor #3 KidsQuilt Camp! (Gr. 3-8) Nine-Patch, Log Cabin, Disappearing Nine Patch: Have you always wanted to make your own quilt? Learn a new quilt block each day, and turn it into your own lap-sized quilt by Friday! Plus, youll learn to use a sewing machine and how to cut quilt squares. Our small, daily projects will add variety to this fun class. Lois Stoll and Nancy Losey, Instructors #4 Theatre 101: Write, Design, and Perform! (Gr. 4-8) Get a crash course in theatre and learn skills for performance through games and activities (acting, speaking, movement, improv”, and more)! Then, enhance your reading and writing skills by reading dialogue and completing your own scripts! Layne Bair, Instructor #5 Art off the Canvas (Gr . 5-8) Have you ever looked at a sculpture and wondered, How is that made?Well be using wood, plastic, clay and found objects to make our own sculptures. Bring play clothesthat can get dirty as we have fun with sculptures and shapes! Pat Rinehart-Irwin, Instructor Culinary Arts #6 Cookie Palooza! (Gr . 4-8) Cookies and Buckeyes and Cake Pops, oh my! Do you want to be an expert confection maker? If so, you will want to join me for a scrumptious week filled with making cookies, decorating them, making Buckeyes, and Cake Pops! Let a notch out of your belt buckle...it's going to be a delicious ride! Tracy Huffman, Instructor #7 Top Chef Cooking Challenge! (Gr. 4-8) Get your aprons ready and your ovens on: we are battling for the premier spot of the ultimate top chef cooking challenge! Five teams will compete daily to win by creating the tastiest, most appealing meal. Sheridon Storm, Instructor #8 The Great Chocolate Caper! (Gr . 3-6) Do you love chocolate? Do you love solving mysteries and using logic? Then The Great Chocolate Caper is for you! Come, join us as we work together to find out who stole the famous chocolate recipe. We will learn about collecting evidence, motives, alibis, and how to rule out suspects until we find the culprit. Each day, we will also make a delicious treat that involves, what else? Chocolate!! Cammie Honaker, Instructor #9 Color, Color, Color! (Gr . 4-6) In this class, we will be exploring the wonderful world of color through fabulously fun, different art-making techniques! We will be drawing, painting, and collaging the most colorful way we know how!! Come join in on the Color FUN! Jennifer Jervis, Instructor Please make selection based on the grade student will enter in the fall. Please make selection based on the grade student will enter in the fall. Please make selection based on the grade student will enter in the fall. Science #26 Wild About Wildlife! (Gr . 3-5) Have you ever seen an animal, bird, or insect and wondered what it is? This class will give you a chance to learn about the wildlife in our area and give you an up close and personal look at the hidden worlds they live in. We will learn about everything from birds and fish to insects and mammals. Well go outside and get our hands dirty! Troy Shively, Instructor #27 Sharks Week (and other fish)! (Gr . 4-8) What are ampullae of Lorenzini? How do sharks sense movement in the water? What happens when a shark loses a tooth? What does dissection of a spiny dogfish reveal about these animals? Learn about density, buoyancy, and more as we learn about some of the most fascinating but misunderstood animals on our planet! Bruce Smith, Instructor #28 Living in Space (Gr . 3-4) Have you ever dreamt of being an astronaut when you grow up? Well, come blast off and explore the life of an astronaut at a International Space Station! We will eat like astronauts and get fit like them, too! It will be out of this world! Patricia Binfet, Instructor #29 Slimy Science (Gr . 2-5) Learn how fascinating chemical and physical changes take place when everyday substances are combined. Make gloop, slime, vomit, floam, and more in this fun, slimy exploration of science! Lucy LeVan, Instructor Social Studies #30 Time Travel (Gr. 4-6) Grab your suitcase and join me on a journey into the world of ancient civilizations starting more than 5,000 years ago! Drink hot chocolate like the Aztecs; design and play Roman games; mold tools like the Vikings; write in hieroglyphs like the Egyptians; and learn about the ancient Chinese warriors! Explore and learn about these fascinating, creative people! Katie Davis, Instructor #31 Native American Culture (Gr . 4-8) Come, discover the rich history of the Shawnee and other First Nations — how they lived, worked, hunted, and dressed! Learn to make Atlati Spears, War Clubs, Fire Starters and Bow Drills as well as skills of Flint Knapping, Hafting and Beading! (Note: students will use some modern tools like glue guns and belt sanders.) Bill Davis, Instructor #32 Help! Im Stuck in a LEGO Movie! (Gr . 3-5) Discover the art of stop-motion and learn history of animation. Be like Walt Disney and make your own flip book story. Then, flash forward to the millennium to create your very own LEGO movie! Develop a simple storyboard; stage the building blocks; and learn how to utilize stop-motion animation techniques to build a short film in small groups out of craft paper or LEGOs! Lauren Burkhardt, Instructor

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Page 1: Health & Wellness What are ampullae of Lorenzini? How do ...ms.benjaminlogan.org/UserFiles/Servers/Server_155471/File...Acting as an architect, you will be designing your dream house!

#18 Magic or Math?? (Gr . 3-4) Have you ever wanted to be a magician? Do you want to astonish your friends and leave them speechless with your amazing tricks? We will get behind the scenes and find out the math behind some pretty neat tricks. But remember...a true magician never reveals his (or her) secrets! Katie Lacher, Instructor

Science #19 The Wonderful World of Wacky Science (Gr . 3-5) Icy volcanoes, electric Pla-Doh©, and elephant toothpaste - all things YOU can experiment with and learn about in the Wonderful World of Wacky Science! You will experiment and create fun, easy science experiments that you can show off to your family and friends using common household items. The Wonderful World of Wacky Science is waiting for you! Becky Lentz, Instructor #20 Space Camp (Gr. 4-6) Rockets, spaceships, and life on other planets - come, explore our solar system beyond Earth. We will explore how to create a spaceship; how to launch it on a rocket; and where it can go! How can you live in space? Where can you go? What do you need? It will be an exciting week of science and engineering learning about Space! Alexa Ramby, Instructor

#21 Dream House Design! (Gr . 4-8) Acting as an architect, you will be designing your dream house! From making blueprints to interior design, you can let your mind run wild: the only barrier holding back your design is your own imagination! Time permitting, we will be making a 3D model of your house that you can take home. Tom Braddock, Instructor #22 Lotions, Potions, and Slime! (Gr . 3-5) Ooey-gooey fun abounds! Explore properties of matter and basic chemistry as we make fluffy slime, unicorn poop slime, magnetic slime, butter slime, and more. On top of that, we’ll become our own bath and body store exploring and inventing lotion, lip balm, and bath bomb recipes. Come: join the messy magic! Ashley Reser, Instructor #23 Hook, Line, and Sinker! (Gr . 4-8) Do you love fishing? Do you want to catch the “big one”? Then gear up and get outdoors! Become better equipped through science to be a successful angler! Let a professional in both education and fishing build your understanding of food webs, tackle selection, and map reading so you can be the best angler on the water! The class will end with a Pro Day on the lake! Ryan Kerns, Instructor #24 Up, Up, and Away (Gr . 3-6) Did you ever wonder how planes that weigh thousands of pounds can fly through the air with the greatest of ease? Then strap in and get ready to explore the skies with us! Become a test pilot for the planes you design and construct. Come away with an understanding of aviation terms along with several airplane designs you can continue to build at home! Kevin Penwell, Instructor #25 CSI Investigation (Gr . 3-4) How do investigators bring the “bad guys” to justice? They use science! Join us as we work side-by-side with real CSI’s to apply science to crime scene investigations. If you like solving mysteries, this class is for you! Jana Core, Instructor

Please make selection based on the grade student will enter in the fall.

#10 Raised in a Barn? Yes, and It’s Awesome! (Gr . 2-8) Did you have ever wonder what it would be like to be a farmer? Do all cows produce milk? How do you milk a cow? Why are some eggs brown and some eggs white? Where do the different cuts of meat come from? Does this affect their taste? In this class, students will learn about various aspects of agriculture. Students will work with livestock and learn how we prepare an animal for the fair along with basic animal care and animal handling. Please note: This class will occur at the fairgrounds. Lora James, Instructor

Health & Wellness #11 Game On! (Gr . 3-8) What did kids do for fun before gaming? Before the internet? In “Game On!”, you’ll join us in experiencing creative, active, and interactive games with simple, everyday objects! We’ll make fun indoor and outdoor games to play with friends, with family, or even by yourself. Join us, and get your game on! Nancy Forsythe and Kathy Dodson, Instructors #12 KidFit (Gr . 2-5) Do you LOVE burpees? Do you love to move? Then grab your water bottle and prepare for action! During KidFit, we will learn how FUNctional fitness and proper nutrition keep our bodies strong and healthy! Come, get your sweat on while having FUN! Lindy Martin, Instructor #13: Kid Fit and Nutrition (Gr . 2-8) Kid fit will focus on fundamental movements in crossfit and nutrition. If you need to move, like us, this is the class for you. We will being doing WOD’s, learning proper technique, and learning healthy eating habits. Art Caudill, Instructor

Language Arts #14 American Girl Adventures (Gr . 2-6) Take an adventure with the original American Girl dolls. We will travel through time, learning about each girl and creating crafts of their era. There’s no need to journey alone, though: we welcome you to bring your own American Girl doll to join us for this fun-filled journey! Candi Bodey, Instructor #15 WPKO & WBLL Sportscaster Camp (Gr . 6-8) At the tenth annual Sportscaster Camp, you will become a celebrity! Learn how to call a baseball game on the radio. This week will include fun training, sports debates, and guest interview, plus YOU will get to be on the radio for a live baseball game and sports talk show. Chad Wilkinson, Instructor

Math and Problem Solving #16 DIY Escape Room (Gr . 6-8) Can your quick thinking help you beat the clock, or will you wind up trapped? Use your brain in new ways during this exciting class! As we work together to design and run our own Escape Room, you will learn how to solve all sorts of locks, codes, and hidden messages. Don't know what an Escape Room is? Watch the first 90 seconds of this video: https://tinylink.net/oKJoj. For a secret message, rearrange the following letters: echo deaRly at green flag? Joanna Reser, Instructor

#17 Straight Line Curves?! (Gr . 4-8) Do you like geometry? How about crafts? Join us this week as we learn how to use nothing but straight lines to make curved designs. We will learn how and why it works; build and practice our skills; create our own designs; and — by the end of the week — we will stitch a design with thread that can be hung up on your wall at home! Shannon Peterson, Instructor

Art, Music & Drama #1 Make It, Take It, Creative Crafts (Gr. 2-3) Enjoy creating cool, new crafts during SEA! Activities include painting, sand art, creating slime, making Pla-Doh©, and tie-dying your own shirt. Roll up your sleeves, and get ready to get messy! Stacey Holycross, Instructor #2 Making Composing a Breeze (Gr. 5-8) Creating your own music can truly be a breeze! In this course, we will use web-based computer software to create mini masterpieces! We’ll learn how to create simple motifs, spoken word chants/cheers, a blues song, commercial jingles and more while learning basic music theory. Plus, we’ll even have a new website where you can continue creating and editing music after class ends! Morissa Sweeney, Instructor #3 Kids’ Quilt Camp! (Gr. 3-8) Nine-Patch, Log Cabin, Disappearing Nine Patch: Have you always wanted to make your own quilt? Learn a new quilt block each day, and turn it into your own lap-sized quilt by Friday! Plus, you’ll learn to use a sewing machine and how to cut quilt squares. Our small, daily projects will add variety to this fun class. Lois Stoll and Nancy Losey, Instructors #4 Theatre 101: Write, Design, and Perform! (Gr. 4-8) Get a crash course in theatre and learn skills for performance through games and activities (acting, speaking, movement, “improv”, and more)! Then, enhance your reading and writing skills by reading dialogue and completing your own scripts! Layne Bair, Instructor #5 Art off the Canvas (Gr . 5-8) Have you ever looked at a sculpture and wondered, “How is that made?” We’ll be using wood, plastic, clay and found objects to make our own sculptures. Bring “play clothes” that can get dirty as we have fun with sculptures and shapes! Pat Rinehart-Irwin, Instructor

Culinary Arts #6 Cookie Palooza! (Gr . 4-8) Cookies and Buckeyes and Cake Pops, oh my! Do you want to be an expert confection maker? If so, you will want to join me for a scrumptious week filled with making cookies, decorating them, making Buckeyes, and Cake Pops! Let a notch out of your belt buckle...it's going to be a delicious ride! Tracy Huffman, Instructor #7 Top Chef Cooking Challenge! (Gr. 4-8) Get your aprons ready and your ovens on: we are battling for the premier spot of the ultimate top chef cooking challenge! Five teams will compete daily to win by creating the tastiest, most appealing meal. Sheridon Storm, Instructor #8 The Great Chocolate Caper! (Gr . 3-6) Do you love chocolate? Do you love solving mysteries and using logic? Then The Great Chocolate Caper is for you! Come, join us as we work together to find out who stole the famous chocolate recipe. We will learn about collecting evidence, motives, alibis, and how to rule out suspects until we find the culprit. Each day, we will also make a delicious treat that involves, what else? Chocolate!! Cammie Honaker, Instructor #9 Color, Color, Color! (Gr . 4-6) In this class, we will be exploring the wonderful world of color through fabulously fun, different art-making techniques! We will be drawing, painting, and collaging the most colorful way we know how!! Come join in on the Color FUN! Jennifer Jervis, Instructor

Please make selection based on the grade student will enter in the fall. Please make selection based on the grade student will enter in the fall. Please make selection based on the grade student will enter in the fall.

Science #26 Wild About Wildlife! (Gr . 3-5) Have you ever seen an animal, bird, or insect and wondered what it is? This class will give you a chance to learn about the wildlife in our area and give you an up close and personal look at the hidden worlds they live in. We will learn about everything from birds and fish to insects and mammals. We’ll go outside and get our hands dirty! Troy Shively, Instructor #27 Sharks Week (and other fish)! (Gr . 4-8) What are ampullae of Lorenzini? How do sharks sense movement in the water? What happens when a shark loses a tooth? What does dissection of a spiny dogfish reveal about these animals? Learn about density, buoyancy, and more as we learn about some of the most fascinating but misunderstood animals on our planet! Bruce Smith, Instructor #28 Living in Space (Gr . 3-4) Have you ever dreamt of being an astronaut when you grow up? Well, come blast off and explore the life of an astronaut at a International Space Station! We will eat like astronauts and get fit like them, too! It will be out of this world! Patricia Binfet, Instructor #29 Slimy Science (Gr . 2-5) Learn how fascinating chemical and physical changes take place when everyday substances are combined. Make gloop, slime, vomit, floam, and more in this fun, slimy exploration of science! Lucy LeVan, Instructor

Social Studies #30 Time Travel (Gr. 4-6) Grab your suitcase and join me on a journey into the world of ancient civilizations starting more than 5,000 years ago! Drink hot chocolate like the Aztecs; design and play Roman games; mold tools like the Vikings; write in hieroglyphs like the Egyptians; and learn about the ancient Chinese warriors! Explore and learn about these fascinating, creative people! Katie Davis, Instructor #31 Native American Culture (Gr . 4-8) Come, discover the rich history of the Shawnee and other First Nations — how they lived, worked, hunted, and dressed! Learn to make Atlati Spears, War Clubs, Fire Starters and Bow Drills as well as skills of Flint Knapping, Hafting and Beading! (Note: students will use some modern tools like glue guns and belt sanders.) Bill Davis, Instructor #32 Help! I’m Stuck in a LEGO Movie! (Gr . 3-5) Discover the art of stop-motion and learn history of animation. Be like Walt Disney and make your own flip book story. Then, flash forward to the millennium to create your very own LEGO movie! Develop a simple storyboard; stage the building blocks; and learn how to utilize stop-motion animation techniques to build a short film in small groups out of craft paper or LEGOs! Lauren Burkhardt, Instructor

Page 2: Health & Wellness What are ampullae of Lorenzini? How do ...ms.benjaminlogan.org/UserFiles/Servers/Server_155471/File...Acting as an architect, you will be designing your dream house!

June 11th-15th, 2018 9:30 a.m. – 11:30 a.m.

Bellefontaine High School

555 East Lake Avenue Bellefontaine, Ohio 43311

Summer Enrichment Academy is designed to provide academic and creative challenges for gifted or highly motivated students entering second (2nd) grade through eighth (8th) grade (in the fall of 2018).

REGISTRATION DEADLINE: FRIDAY, April 13th, 2018

SEA is coordinated by Bellefontaine City Schools, Benjamin Logan Local Schools, Ridgemont Local Schools, and the Midwest Regional Educational Service Center

(in cooperation with Indian Lake Local Schools and Riverside Local Schools).

Please contact these SEA Coordinators for more information:

Angie Horvath, Bellefontaine City Schools Sally Stolly, Benjamin Logan Local Schools [email protected], 937 593-0545 [email protected], 937 593-9211 Jennifer Frederick, Ridgemont Local Schools Erica Baer, Midwest Regional ESC [email protected], 937 354-2141 [email protected], 937 498-1354, x7004

Special Thanks to our 2018 SEA Brochure Sponsor!

2018 SUMMER ENRICHMENT ACADEMY June 11th-15th, 2018

REGISTRATION AND EMERGENCY MEDICAL INFORMATION

When scheduling, we will do our best to assign students to their first (1st) or second (2nd)choice. Classes require a minimum of ten (10) students. SEA reserves the right to: Cancel a course due to insufficient enrollment; schedule students in any of their designated choices; and/or remove students who present a discipline problem.

Please send non-refundable check of $60 per student (along with this form)

by April 13th, 2018 (payable to Bellefontaine City Schools) to:

Bellefontaine City Schools Attn: Treasurer’s Office

820 Ludlow Road Bellefontaine, Ohio 43311

Note: Sponsors have provided financial assistance to students on the Free and Reduced Lunch Program. The registration fee will be reduced to $15 per student. Please send non-refundable check for $15 with registration.

Each participant will receive a t-shirt. Please circle size: Youth: M (10-12) L (14-16) Adult: S M L XL

Class assignment notification will be sent home from school with your child (not mailed) by:

May 11th, 2018.

*To enable parents/guardians to authorize the provision of emergency treatment for their children who become ill or injured while attending SEA, please list three (3) contact names and phone numbers:

*Consent to Treatment: In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for: (1) the administration of any treatment deemed necessary by the below named physician or dentist; and (2) the transfer of the child to any hospital reasonably accessible:

This authorization does not cover major surgery unless the medical opinions of two licensed physicians or dentists, obtained prior to the performance of such surgery, concur in the necessity for such surgery. *Facts concerning the child’s medical history, including allergies, medications being taken, dietary restrictions, and any physical impairments: ________________________________________________________________________________________ *The SEA staff will not be responsible for medications. Please list all medications, if any, will your child be carrying with him/her during SEA: ________________________________________________________________________________________

Disclaimer: I authorize SEA to consider my child’s photograph/image/name as “directory information” and to utilize, release, and/or publish my child’s photograph/image/name in all school/media publications.

Signature of Parent/Guardian: ____________________________ Date: _______________ Phone:___________________

Student’s Name Parent’s Name School

Address Primary Phone Teacher

City, State, Zip Alternate Phone

Grade Entering in Fall 2018: (Please circle one) 2 3 4 5 6 7 8

Classes: Please list your choices below. ***Must enter two (2) choices to be registered!*** **Course placements are final!**

1st Choice # Title

2nd

Choice # Title

3rd

Choice # Title

Name Relationship to Student Phone Number

1

2

3

Physician Phone Dentist Phone

Specialist Phone Hospital Phone

2018