Northern Kentucky University
Latino Science Camp 2007
Pre-Registration: Must be received by May 11, 2007
Date/Time of Event: June 11-15, 2007, 9:00 am
- 4:00 pm
Come & Have Fun
Lunch will be provided
Did you remember the letter of
recommendation and the $25 check?
Name:__________________________________________________________________
Address:________________________________________________________________
City/State/Zip:_______________________________H.S.
Name:___________________
Grade:__________Age:_____
Sex:___ Tel.: _____________Email_________________
Address:________________________________________________________________
Please send applications to: Leo Calderon
Latino
Student Affairs
Northern Kentucky
University
Nunn Drive,
University Center
372
Highland Heights, KY 41099
On the behalf of myself, my heirs, executors, estate, successors, and assigns, I hereby release Northern Kentucky University, sponsors, affiliates, managers, coordinating groups, volunteers and all other individuals, groups, and entities associated with this event, as well as their affiliates agents, employers, directors, officers, and member, from all claims which may arise from or as a result of my participation in the Science Camp. In consideration of the acceptance of my entry and my participation in this even, I understand and agree that I give this release to the full extent permitted. I certify that I am physically fit and able to participate in this event, and agree to assume all risks of my participation.
Signature of
Participant:__________________________________ Date:________________________
Signature of
Parent or Guardian, if under 18:________________________ Date:___________________
Emergency
Contact:_________________________________ Phone Number:____________________
WILL YOU NEED A RIDE TO NKU? ______ DATES WHEN RIDES NEEDED: _______________________________
Pick up/
drop off point: Su
Casa___
Centro de Amistad ____
If you have any questions, please contact Leo Calderon or Carmen Kirchgassner at 859-572-6013
or kirchgassc1@nku.edu, Fax: 859-572-1576