In Action Summer Camp Registration Form (1)

2024 Summer Registration Form

Chicago In Action Studio

5901 W. Irving Park, Chicago IL, 60634

chicagoinactionstudio@gmail.com

Name

First NameLast Name

Nickname

Address

City

State

Zip code

Parent Guardian 1

Email

example@example.com

Phone

Work Phone

Emergency Contact

Name

Phone

Parent Guardian 2

Email

example@example.com

Phone

Work Phone

Name

Phone

Program Preference

Week 1-3 (6/24-7/12)Week 3-6 (7/15-8/2)Full Program (6/24-8/2)

Payment Information:

If your family is capable, we invite you to pay

Full cost of $425 or half-cost $212.50 for weeks 1-3.

Full cost of $450 or half-cost $225 for weeks 3-6.

Full Program of $875 or half payment of $437.50

Deposit of $100 to register is non-refundable for summer camp program. Deposit will apply to program fee.

Full payment or half payment is due 2 weeks prior to fisrt day of camp. If you choose half-payment the remaining balance will be due 2 weeks after camp starts.

Please note that for half payments we do ask to leave a card on file.

Amount of Deposit or Full/Half Payment Enclosed

Card Holder Signature

Billing Zip Code

Name On Card (please print ): To the best of my knowledge, all registration information for the person described herein is correct. I give permission for my child to participate in all camp activities, including but not limited to: walking to Portage Park and activities in camp. I agree that the camp, its staff, volunteers, and the owners will not be held responsible for any accidents or personal injury, or illness (including COVID-19) arising from participation therein. I agree that the camp or its staff will not be held responsible for lost personal property. I also grant permission for pictures or video taken of the individuals listed above to be used in publications and promotional materials.

Signature

Date

My Products*

Deposit Deposit is to secure your spot. Deposit is non-refundable or transferable. Deposit applies toward program cost.

$100.00 Quantity
Item subtotal:$0.00

Kid In Action Summer CampKids In Action Summer Camp 2024 Check box and select your program option cost. Deposit is already applied to camp price.

$775.00

Half Payment for Full Program	Quantity	Price
Full Program 6/24-8/2 2024		$775.00
Half payment for Full Program 6/24-8/2 2024		$337.50
Week 1 - 3 Full Payment 6/24-7/12		$325.00
Week 1-3 Half payment 6/24-7/12 2024		$112.50
Week 3-6 Full Payment 7/15-8/2		$350.00
Week 3-6 Half Payment 7/15-8/2		$125.00

Item subtotal:$0.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer