Mount Vernon Nazarene University: Life Changing
Registration Form for Pre-School

This page is undergoing maintenance. Please do not use. We are not responsible for lost registrations.

Summer Quest 2013 is here! We have an amazing selection of quests to offer this year. We are excited about our new one-week format for our Science Quests and our tried and true two-week format for our Reading Recharge Quest!

Please note that if you are registering more than one child, you must complete a separate registration for each child. Registration is not complete until you have completed the online payment screen. Any cancellations must be taken care of at least seven (7) days before the start of the quest in order to receive a refund.

We can't wait for our quests to begin! This is going to be a GREAT SUMMER!


Science Camps:

July 8-12 (Open: FULL) (Open: 19/20)
July 15-19 (Open: 19/20) (Open: 20/20)
July 22-26 (Open: 20/20) (Open: 17/20)
July 29-Aug. 2 (Open: 20/20) (Open: 19/20) (Open: 18/20)

Reading Camps:

July 8-19 (Open: 14/20)
July 22-Aug. 2 (Open: FULL)

Student's Name:
Date of Birth: (mm/dd/yyyy)
Grade completed as of June 2013:
School Attended:
Teacher's Name:
Teacher's Email Address:
Permission to contact the child's teacher
to obtain current reading levels?
T-Shirt Size:
Child's Interests or Hobbies:
Permission to use the child's photo
for print or web publicity?

Parent/Guardian First Name:
Parent/Guardian Last Name:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Cell Phone:
Email:
Just for fun: What words best describe your child's opinion of coming to MVNU Summer Quest?:

Medical Information:
Emergency Contact Name:
Emergency Contact Number:
Primary Doctor:
Primary Dentist:
Does your child have allergies?
If yes, please list:
In the event of a medical emergency and I cannot be reached, I give permission for my child to be treated by the doctor listed above and/or Knox Community Hospital.
Additional medical information MVNU Summer Quest should be aware of in advance:

Payment Method
Credit Card Online
Check Online
Check by Mail
Total: $

 
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