RUSSIAN EDUCATIONAL CENTER OF MINNESOTA
17937 LIV LANE, EDEN PRAIRIE, MN 55346

Registration Form
SUMMER CAMP
2009 - 2010 school year

Make checks payable to RUSSIAN EDUCATIONAL CENTER OF MINNESOTA (RECM)
A non-refundable $20.00 annual registration fee per family (new students only) and the first payment of $50 is due with this registration!
You can mail your registration form and check or money order to:
RUSSIAN EDUCATIONAL CENTER OF MINNESOTA (RECM)
17937 LIV LANE, EDEN PRAIRIE, MN 55346


Student's name:_____________________________________ Age: ___ Birthday: _________ M or F

Class Name:____________________________________ Day:___________Time:_________________

Second Class Name:_______________________________ Day: __________ Time: ____________

Tuition: (-10% discount on lesser fee and/or second, third, etc. student):_______________________

TOTAL TUITION ENCLOSED:____________________________

Family Information

Mother's/Guardian's Name:____________________________________________________________

Father's/Guardian's Name:____________________________________________________________

Street Address:_____________________________________________________________________

City: ___________________________________Zip:______________

Home Phone: (____)____________ Cell phone:______________ E-mail: _____________________

HOW DID YOU HEAR ABOUT US? __________________________________________________

Emergency Contact and Phone Number:_______________________________________________

Allergies and/or other medical conditions:______________________________________________

Insurance Company:_______________________________ Policy Number: __________________

Physician:________________________________________ Phone Number:__________________



Student/Parent/Guardian Signature:__________________________________Date:_________