Parent or Guardian:
Home Phone Number:
Work (cell) Phone Number:
Emergency Name:
Emergency Phone Number:
Street (Mailing) Address:
Student Name:
 Age:
6 Week Session $149
Day of Week
Time (Select One)
Session 1 (S1) Oct 13- Nov 22
Session 2 (S2) Dec 1- Jan 24, 2009
Session 3 (S3) Jan 26 - Mar 7
Session 4 (S4) Mar 9 - Apr 25
Session 5 (S5) Apr 27- June 6
Monday
3:30 - 4:30
Keyboarding
Keyboarding
Keyboarding
Keyboarding
Keyboarding
4:45 - 5:45

Maya
Programming
in C++
Robotics
Web Design
Game Design
Tuesday
3:30 - 4:30
Web Design
Robotics
Game Design
Maya
3D Game Mapping
4:45 - 5:45
Keyboarding
Keyboarding
Keyboarding
Keyboarding
Keyboarding
Wednesday
3:30 - 4:30
Programming
in C++
3D Game Mapping
Web Design
Game Design
Maya
4:45 - 5:45
Keyboarding
Keyboarding
Keyboarding
Keyboarding
Keyboarding
Thursday
3:30 - 4:30
Keyboarding
Keyboarding
Keyboarding
Keyboarding
Keyboarding
4:45 - 5:45
Game Design
Web Design
3D Game Mapping
Programming in C++
Robotics
Friday
3:30 - 4:30
Keyboarding
Keyboarding
Keyboarding
Keyboarding
Keyboarding
4:45 - 5:45
Robotics
Game Design
Maya
3D Game Mapping
Programming in C++
Saturday
10-11 AM
3D Game Mapping
Maya
Programming in C++
Robotics
Web Design
11AM-12PM
Keyboarding
Keyboarding
Keyboarding
Keyboarding
Keyboarding
Total Amount Due:
Method of Payment:
Check
VISA
M/C
Discover
AMEX
Card Number Expiration Date
Sorry, we cannot hold a position in any of our classes until payment is made in full.
I, the undersigned, as legal parent or guardian of a minor, do hereby authorize CYBERSTORE to secure medical services in the event that he/she is in need of emergency medical care. I understand that neither CYBERSTORE nor its representative(s) assume any financial responsibility for such treatment. I further agree to allow any camp projects or photographs to be used for advertising purposes only. This authorization shall remain in effect unless revoked in writing and delivered to said agent(s).
Signature ___________________________________
To finish the registration process:
1. Fill out and then print this form
2. Send this form to CYBERSTORE via fax, mail, or telephone
FAX: (858) 755 - 8251
Telephone: (858) 792 - 2500
Mail: CYBERSTORE,
981-D Lomas Santa Fe Dr.
Solana Beach, CA 92075
3. You should receive a confirmation letter within a few days!