468 N Ken Gray PkwyIna, IL 62846618-437-5321

www.rlc.edu

Please let us know in the event your child is unable to attend.

Submit application to: Community & Corporate Education

Rend Lake College 468 N. Ken Gray Parkway

Ina, IL 62846

or email to commcorped@rlc.edu

or call for more information (618) 437-5321, Ext. 1714

Join the conversation.

Parent/Guardian Consent and Press Release:

I hereby give permission for my son/daughter, whose name appears on this application, to participate in the Discovery Camp 2017 at RLC, Ina, IL on June 20 and 21, 2017. Furthermore, I understand that the organizations/agencies that are sponsoring this event are not liable for any injury or accident, which may be suffered by my son/daughter during the camp. We realize that photographs/videos will be taken at this Rend Lake College event. I grant permission for the South Central Illinois AHEC and Rend Lake College to disclose my child’s identity and to reproduce and distribute photographs of my child while participating in the Rend Lake College Discovery Camp to local radio, newspapers, television, and other social media forms.

I plan to attend with my child

Parent/Guardian (printed)

Parent/Guardian Signature

Date:

Rend Lake CollegeDISCOVERY CAMP

June 20-21, 2017

You are the next generation of professional.

Find your calling at

Highlights of the camp include information on health careers in the fields of Emergency Medical Services, Radiology, Nursing, Medical Coding, Health Information Technology, Air Evacuation, Phlebotomy, Certified Medical Assisting, and many others.

But what will your profession be? Navigating what career might be right for you can be overwhelming. We’re here to help. With Rend Lake College’s Discovery Camp, you will learn about health careers by attending fun and interactive sessions. Oh Yeah. We’ll also feed you and send you home with a free tee shirt.

Two-Day CampJune 20 - 21, 2017

No Camp Fees

Parent/guardian welcome to attendStudent First Name: ________________________

Student Last Name: ________________________

Address: _________________________________

City: ____________________________________

County: ____________ Zip: ________________

Home Ph: __________ Cell Ph: _____________

E-mail: ___________________________________

Student Gender (please circle): Male Female

T-Shirt size preferred (please circle): S M L XL XXL

School: __________________________________

Current Grade / Year in School: _______________

Students must be in incoming grades 7-12

Transportation to camp on both days will be provided by establishing a few pick-up/drop-off points throughout the area. Please answer the following by selecting one of the following:• My child will need transportation • My child will not need transportation My child will be arriving to camp by: (self-transportation) parent/other Please print the name of the person that will be providing transportation for your child

scenes fromDISCOVERY CAMP

rend lake college

DISCOVERY CAMPregistration application

Interested in a health care field?

We’re here to help!

For questions, call or emailRLC’s Community &

Corporate Education Division 618.437.5321, Ext. 1714commcorped@rlc.edu