Summer Camp Registration Summer Camp RegistrationChild Name* First Last Sex*Age*Date of Birth (MM/DD/YYYY)*Father’s Name* First Last Parent Email* Cell Phone*Mother’s Name* First Last Parent Email* Cell Phone*Address* Street Address City State / Province / Region ZIP / Postal Code Home PhoneEmergency Contact 1*Home Phone*Emergency Contact 2Home PhoneIs there any medical, environmental, or history that would be useful in helping to understand your child?Child’s Pediatrician Name*Home Phone*Address*How did you hear about our school?*Tuition fee per weekPlease select the schedule*5 Full Day (3-7 years) 8:30am – 3:30pm4 Full Day (3-7 years) 8:30am – 3:30pm3 Full Day (3-7 years) 8:30am – 3:30pm5 Extended Full Day (3-7 years) 8:30am – 5:30pm4 Extended Full Day (3-7 years) 8:30am – 5:30pm3 Extended Full Dayy (3-7 years) 8:30am – 5:30pm5 Half Day AM (3-7 years) 8:30am – 1:00pm4 Half Day AM (3-7 years) 8:30am – 1:00pm3 Half Day AM (3-7 years) 8:30am – 1:00pm5 Full Day (18 months-3 years) 8:30am – 3:30pm4 Full Day (18 months-3 years) 8:30am – 3:30pm3 Full Day (18 months-3 years) 8:30am – 3:30pm5 Extended Full Day (18 months-3 years) 8:30am – 5:30pm4 Extended Full Day (18 months-3 years) 8:30am – 5:30pm3 Extended Full Day (18 months-3 years) 8:30am – 5:30pm5 Half Day AM (18 months-3 years) 8:30am – 1:00pm4 Half Day AM (18 months-3 years) 8:30am – 1:00pm3 Half Day AM (18 months-3 years) 8:30am – 1:00pmPlease indicate desired week or weeks:* June 30 July 7 July 14 July 21 July 28 August 4 August 11 August 18 August 25 Will you need extended care?*YesNoCheck the extended care option* AM (7:30am - 8:30am) PM (3:30pm - 5:30pm) Check the box beside the statement:* Tuition payments are due on the first day of each month/week. I agree to follow the school policies as described in the Summer Camp Confirmation Letter. Signature*Date* Date Format: MM slash DD slash YYYY
