Kids on Campus Payment Phone – 740-474-5383 Email – highered@pickaway.org Student Name(Required) First Last Parent/Guardian Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Alternate PhoneEmail(Required) School District(Required)Select one...CirclevilleLogan ElmTeays ValleyWestfallOtherStudent's Grade in 22/23 School Year(Required)Select one...2nd Grade3rd Grade4th Grade5th GradeT-Shirt Size(Required)Select one...Youth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLSessionsSessions are $50 each. Reminder: Choose the grade level for the next school year.June 6-10th Morning Sessions: 10:00am-12:00noon No session Grade 2/3 Music Grade 2/3 Science Grade 2/3 Technology Grade 4/5 Math Grade 4/5 Visual Arts June 6-10th Afternoon Sessions: 1:00pm-3:00pm No session Grade 2/3 Music Grade 2/3 Science Grade 2/3 Technology Grade 4/5 Math Grade 4/5 Visual Arts June 13-17th Morning Sessions: 10:00am-12:00noon No session Grade 2/3 Math Grade 2/3 Visual Arts Grade 4/5 Music Grade 4/5 Science Grade 4/5 Technology June 13-17th Afternoon Sessions: 1:00pm-3:00pm No session Grade 2/3 Math Grade 2/3 Visual Arts Grade 4/5 Music Grade 4/5 Science Grade 4/5 Technology Consent I grant permission for my child's photo/name to appear in the media as a participant in Kids on Campus.Payment Options(Required) I will pre-pay with a check. I will use PayPal online. Total