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EARLY BIRD PRICES till May 1, 2013




Page 1 of 3

Registration for Summer Camp 2013

Child's Information:

Child's Name(*)
Please type child's full name.

Date of Birth(*)
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M / F(*)
Gender

Are there any Medical Conditions to which we should be alerted(*)
Are there any Medical Conditions to which we should be alerted?

Description
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Legal Guardian's Information:

Full Name(*)
Legal Guardian's Full Name

Address(*)
Street Address

City / State / Zip(*)
City / State / Zip

Phone
Phone

E-mail(*)
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Emergency Contact:

Mother's Name
Mother's Name

Mother's Phone
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Father's Name
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Father's Phone
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How should we contact you?
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When would you like to be contacted?
Please select a date when we should contact you.

Your Message
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Week 1 (June 24 - 28)
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Week 2 (July 1 - 3), prorated for July 4-5
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Week 3 (July 8 - 12)
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Week 4 (July 15 - 19)
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Week 5 (July 22 - 26 )
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Week 6 (July 29 - Aug 2)
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Week 7 (Aug 5 - 9)
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Week 8 (Aug 12 - 16)
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Week 9 (Aug 19 - 23)
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Week 10 (Aug 26 - 30)
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Registration Fee (waived for current members)
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effective from March 1 through August 31, 2013
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CAPTCHA Antispam(*)
CAPTCHA Antispam
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Total
0.00 USD

Payment Method:

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