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My Doll & Me Summer Camp is fun for ages 6-10. No dance experience necessary. We will do crafts, games, dances and have a snack each day. Enroll in January to receive the Early Bird Price of $140 a week, Enroll in February-April for the Price of $160 a week, Enroll in May-July for the Price $175 a week. **January Only-Register for 2 camps & get $10 off the 2nd camp**
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
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- denotes required fields
Family Information
First Name:
*
Last Name:
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Type
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Doctor/Physician
Father
Grandparent
Guardian
Mother
Other
Parent
Step Father
Step Mother
Home Phone:
Cell #:
Work #:
Email:
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(Emails are kept confidential)
Address:
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City:
*
State:
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AK
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AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
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KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
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NJ
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OK
OR
PA
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Zip:
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Students entered below will be added to your family's account
Add New Student #1:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Please put NONE if none):
Allergies (Please put NONE if none):
Medications (Please put NONE if none):
OK to give Tylenol 500mg?:
*
OK to give Advil 200mg?:
*
Add New Student #2:
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Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Please put NONE if none):
Allergies (Please put NONE if none):
Medications (Please put NONE if none):
OK to give Tylenol 500mg?:
*
OK to give Advil 200mg?:
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Please put NONE if none):
Allergies (Please put NONE if none):
Medications (Please put NONE if none):
OK to give Tylenol 500mg?:
*
OK to give Advil 200mg?:
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Please put NONE if none):
Allergies (Please put NONE if none):
Medications (Please put NONE if none):
OK to give Tylenol 500mg?:
*
OK to give Advil 200mg?:
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Student Email:
Disabilities (Please put NONE if none):
Allergies (Please put NONE if none):
Medications (Please put NONE if none):
OK to give Tylenol 500mg?:
*
OK to give Advil 200mg?:
*
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number:
*
Visa
Mastercard
Discover
Name as it appears on card:
*
Nickname:
Card Expiration Month:
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Exp Year:
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2025
2026
2027
2028
2029
2030
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2032
2033
2034
2035
2036
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2050
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2055
Address Line 1:
Address Line 2:
City:
State:
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
PR
VI
Zip:
*
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