EYES February Winter Break Program Registration

February Break Program - February 17-21, 2023

Please take a moment to register for Tommy Nobis Center's EYES February Break Program. Space will be limited for students to enjoy a little learning and a lot of fun!

During our February Break Program we will be on-site providing pre-employment services, fun activities, and outings. Students are only able to attend one School Break Camp (Fall, Winter, Spring) per school year.

*Our Early Youth Employment Services (EYES) serve students 14-21 years old with a documented disability*

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* 1. Please confirm you have read the information above.

Yes

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* 2. Please choose your Winter Break Camp Location

Tommy Nobis Center - 240 Interstate North Parkway, Atlanta, GA 30339

Center for Visually Impaired - 739 W Peachtree St NW, Atlanta, GA 30308

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* 3. Student Name

First Name

Last Name

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* 4. Student Address

Street

City

State

Zip code

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* 5. Student Phone Number

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* 6. Student Email Address

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* 7. Student Date of Birth

DOB

Date

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* 8. Student's School

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* 9. Does your child have food allergies or sensitivities? If so, please specify below.

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* 10. Parent/Guardian Name

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* 11. Parent/Guardian Phone Number

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* 12. Parent/Guardian Email Address

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* 13. Student T-shirt Size

Small

Medium

Large

X-Large

2X-Large

3X-Large

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* 14. You're almost finished registering! Parents we will send you more information on orientation and additional needs via email. Please check your spam and junk folders for future communications.

Great!