Summer Camp Registration

My child will attend camp on the following weeks:

June 9 - 13 July 7 - 11
June 16 - 20 July 14 - 18
June 23 - 27

Child's Name
Age as of 1/1/08
Parent's Name(s)
Address
E-mail
Phone
Emergency Contact
Emergency Phone
Total Deposit^*	weeks x $100 =
Extended Care until 4:00 pm @ an additional $50 per week	Yes No
If paying with credit card:	Card# Exp 3-digit code Signature__________________________

^{*$100 per week deposit holds a space for
this camp participant and is non-refundable.}