Summer Camp 2017 Registration
June 26 - August 18, 2017
(open)7am - 6pm (close)
Spaces are Limited!
8 Weeks for $75/week


Payment options available!



Payment options:
1. $75/week + $15 (Registration Fee) = $85 (Payments are due Every Monday)
2. $300 + $15 (Registration Fee) = $315 (Payments are due Every Monday)
3. $540 + $15 (Registration Fee) = $555 (%10 Discount!) 
*An Application Must Be Completed for Each Child*
Name:
Birthdate:
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Age:
Home Phone:
-
E-mail:
Address:
Mother's Name:
Employer:
Cell Phone:
-
Father's Name:
Employer/father:
Cell Phone/Father:
-

Medical

Physician’s:
Physician’s Phone:
-
Is your child on medication that we need to know about? :
If yes, please explain:
In Case of Emergency, Contact:
Relationship to student:

Your child will be released only to the parents/ guardian or the following persons(s)

Name, Phone, Cell Phone:
Name, Phone, Cell Phone:(1)

Parent Agreement and Consent

1. I understand that the tuition for the Summer Enrichment summer program is $600 in full or $75/week for the entire program summer and is Non-Refundable once the program starts.

2. I understand that the Summer Summer Enrichment Program will be open Monday-Friday, 7:00 a.m. to 6:00 p.m., and will be closed for the 4th of July Holiday.

3. My child has permission to participate in field trips and swimming activities; and can be transported by Summer Summer Enrichment Program Staff.

4. In the event of an emergency, the staff of the Summer Enrichment Program may administer first aid to my child or obtain emergency treatment, if necessary. I also understand that the staff can only administer dated, labeled and prescribed medication. I realize that I must leave written permission before my child can be administered his/her medication.

Certification: I certify that I have read and understand this application.

Signature (type name):
Date:
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