LYON COLLEGE S.A.F.A.R.I. Application Form
SECTION I STUDENT INFORMATION (to be completed by parents)
Student Name Grade Completed
Age DOB SSN
Name of parent/guardian
Telephone #: Home Work (Dad) Work (Mom)
Cell phone # (Dad) Cell phone # (Mom)
Email Address
Address
City State Zip
T-shirt Size (check one) YS YM YL AS AM AL
Extra t-shirt ($7 each) Yes No (If yes, how many?)
SECTION II COURSE SELECTION
Check one: Both sessions Session I Session II
Half day session (Grades K-2 only)
Preference: AM PM Mid-day
Prefer 2 Academics Prefer 1 Aca, 1 Rec
Lunches: Yes No
All course numbers are listed below. Please rank the academics in terms of your preference, giving a "1" to your first choice, a "2" for your second, a "3" for your third choice, etc. Do the same with the recreational courses. Please do not choose a class unavailable to your grade (remember, it is the grade you have just COMPLETED). Number ALL courses that fit your grade level. Returning students: Mark classes you’ve already had before with an "H". Courses offered both sessions unless stated otherwise.
COURSE NUMBERS & GRADE LEVEL
Academics
CN2001 (K-3)
CN2002 (4-6)
CN2003 (K-6)
CN2004 (4-6)
CN2005 (4-6)
CN2006 (4-6)
CN2007 (4-6)
CN2008 (K-3) CN2009 (4-6) CN2010 (K-3) CN2011 (4-6)
CN2012 (K-6)
CN2013 (4-6)
CN2014 (4-6)
CN2015 (K-3)
CN2016 (K-3)
CN2017 (K-3)
CB2018 (K-6)
Recreational
RCN001
RCN002 (4-6)
RCN003
RCN004 (K-6)
RCN005 (K-6)
RCN006 (K-6)
FEES
Full day—$310 for 1 session, $560 for 2 sessions. First sibling $260 for 1 session, $460 for 2 sessions. Half-day—$170 for 1 session, $300 for 2 sessions. First sibling $140 for 1 session, $250 for 2 sessions. Please include an extra $30.00 if you want your child to have lunch each day (1/2 day students only—lunches are included in full day program). Fill in a separate application for each sibling. All fees include a required camp insurance.
Checking this button indicates my electronic signature.
