Renaissance Middle School AVID Summer Bridge Camp

Application Form
Return completed form to Ms. Ballard at Renaissance Middle School, 7155 Hall Road
Fairburn, GA 30213

Student Information

Last Name: First Name: Middle Name:

Address:

Parent or Guardian Phone Number:

Parent or Guardian Email Address:

Please select the RMS AVID Summer Bridge Camp that your scholar will
attend:
___ Returning 7th Grader Math for 7th Grade June 1-16, 2017
(8:30AM-12: 30PM)
___ Returning Rising 8th Grader Algebra Readiness June 1-16, 2017
(8:30AM-12: 30PM)
_______New Rising 8th Grader Mission Possible June 1-16, 2017
 ___ New Rising 7th Grader Math for 7th Grade June 1-16, 2017
(8:30AM-12:30PM)

Parent/Guardian #1 Information

Last Name: First Name:

Parent/Guardian #2 Information

Last Name: First Name:

Cell Phone Number: Work Phone Number:

Emergency Contact Information

Last Name: First Name:

Cell Phone Number: Work Phone Number:

Student Census Information

Gender: M/F Home Language:

Ethnicity - Is your student Hispanic: Y/N Race:

Cell Phone Number: Work Phone Number:

Health Concerns:

Please list any food allergies or dietary restrictions your student has:

Please list any other allergies your student has (plants, insects, latex, etc.)

Please list any health concerns for your student:

T Shirt Size (circle one):

Small

Medium

Large

X-Large