Registration

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This is for Summer Camp for the FULL 8+ weeks, running May 28th through July 30th. This is the pay-in-full price and includes these 8+ weeks: May 28 - May 31, June 3 - June 7, June 10 - June 14, June 17 - June 21, June 24 - June 28, July 8 - July 12, July 15 - July 19, July 22 - July 26 July 29 & July 30

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Home Phone:	Cell #: Work #:
	Email:	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *

Students entered below will be added to your family's account

Additional Information:

Other Questions/Comments:

Credit Card Verification:

Card Number: *

Name as it appears on card: *

Nickname:

Card Expiration Month: *

Exp Year: *

Address Line 1:

Address Line 2:

City:

State: Zip:*