Teacher Contact Information

Name

Email

School Contact Information

School Name

Grade(s) you teach

Number of students

School County

School District

School Address

City State
Zip

School Phone
School Fax

Principal Name

Principal Email

Teacher Home Address

City State
Zip

Home Phone

Home fax

Requested User Name

Requested Password

I understand that my Camp Internet Subscription includes complete access to all classrooms including the following Camp Internet Online Expeditions:

Discover the California Channel Islands

Explore the Ancient Southwest

American History

Explore the Global Garden

Discover the California Backcountry

Explore GIS & GPS Mapping

Services Ordered
I am ordering the following services :

Payment Method

I am submitting a purchase order

Agency issuing PO:

Contact for PO - Name
Phone Fax
PO#
PO#
PO#

The following is for teachers subscribing individually, rather than through a district or school Purchase Order:

I will be paying by credit card MC Visa Am Ex
In Full - or - Monthly over 12 months

Card #
Exp Date
Card Holders Name
Card Holders Address

I will be paying by check

Agreement

This enrollment agreement includes opportunties for training for myself, online programs for my students,and optional mateirals and/or live training. By enrolling, I agree, on behalf of my school or agency, to pay the program package costs, and will be responsible for any travel or field costs or liabilites. I and my 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
PO Box 325
Buellton, CA. 93427
(if you decide later to make changes on this form, do so by hand and send in with signature)

Signature
Date
Thanks for Enrolling!
Questions? Call 1-877-889-2823, or email rain@rain.org