Camp Internet District Application

We are enrolling in Camp Internet as:

New participants Returning Campers
And will be including:
Teachers Afterschool Program Leaders Librarians Technology/Lab Coordinators

We are enrolling Teachers in the following Camp Internet Online
Expedition Themes:

Qty Discover the California Channel Islands (suggested for grades 4-9)

Qty Explore the Ancient Southwest (suggested for grades 5-9)

Qty American History (suggested for grades 5-12)

Qty Global Garden Class (suggested for grades K-12)

Qty Discover the California Backcountry (suggested for grades 4-9)

Qty GPS & GIS Mapping Class(applicable all grades, higher level projects available                 for 4th-12th grades)

Services Ordered
We are ordering the following services and/or products:

I. We are enrolling teachers in the year round online program, with student activities and online professional development, at the discount rate selected in the following drop down box:

We are ordering (qty of each type)

GPS units Digital Cameras Video Cameras Scanners
as part of our Tool Kit (one each per kit)

II. Tool Kit & Program cost :$

 

III. Live Teacher Training Workshops (highly recommended for every teacher)

$350 for one / $335 each for 2-9 Qty or
$375 for one / $360 each for Santa Rosa Island session Qty

 

Total - all services and products combined: $

Contact Information

District Contact

District Contact's Work Email

Agency Name

Location - Street Address

City State Zip

Contact Phone Contact Fax

URL

Superintendent's Name

Superintendent's Email

We are also ordering the following (tax and handling/shipping incl):

GPS unit/s $120 each                                  Set of 25 passports & stickers $50 each
Digital Still Camera/s $120 each                Additional Mascots $12 each
Digital Video Camera/s $120 each            Additional Mousepads $8 each
Scanner/s $120 each                                    Field Notebooks $8 each
Other

Payment Method

I am submitting a purchase order/s for the district's enrollment ( you can provide one PO or seperate for program/materials/training)

Agency issuing PO:

Contact for PO - Name
Phone Fax
PO# PO# PO#
Address
City State Zip

We would like to apply for a RAIN, USDA or BIA School scholarship for
teachers to cover the cost of their .

Names of teachers if known (can be submitted later) and grade levels, with
their email addresses and subject track (Southwest, Islands etc.)::

Agreement

This enrollment agreement includes opportunties for live training for our teachers, online programs for students, and optional materials. By enrolling, I agree, on behalf of agency, to pay the program package costs, and will be responsible for any travel or field costs or liabilites. Our teachers and students will observe the Camp Internet Accpetable Use Policies for responsible online activities and we will participate fully to the best of our abilities.

Please print, then submit online, and then sign this application/mail a hard copy to
Camp Internet
1129 State Street A7
Santa Barbara CA 93101
(if you decide later to make changes on this form, do so by hand and send in with signature)

Once the district application is submitted, please have each participating teacher use the individual enrollment form to register.


Signature
Date
Thanks for Enrolling !
Questions? Call 1-800-889-2823, or email explore@campinternet.net