Summer Camp Registration Form

Summer Camp Registration 2024

Catch up! Keep up! Reach Ahead!
Parent/Guardian Info
Name*

First NameLast Name
e-mail*
Primary Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Postal Code
Emergency Contact (If Parent/Guardian cannot be reached)*
Relationship to Student*
Emergency Phone*

Area CodePhone Number
Billing Info
Billing Infomation differs from Parent/Guardian Information
Please note: Parent/Guardian listed above assumes primary responsibility for account maintenance. Billing Info is for contact information only.
Billing Name*

First NameLast Name
e-mail*
Primary Phone Number*

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Info
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age
Grade in School 2023-2024
Student email
Student Cell Phone

Area CodePhone Number
New or Returning Student?*

Returning StudentNew Student
Number of Years at Thornhill Learning Center
Full Time Options
Part-Time Options
Summer Camp Availability *
Optional: Summer Camp Availability
Optional: Summer Camp Availability
Course Cost
Add Student 2?

Add Student 2
Student 2 Info
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age*
Grade in School 2023-2024
Student email
Student Cell Phone

Area CodePhone Number
New or Returning Student?*

Returning StudentNew Student
Number of Years at Thornhill Learning Center
Full-Time Options
Part-Time Options
Summer Camp Availability*
Optional: Summer Camp Availability
Optional: Summer Camp Availability
Course Cost
Add Student 3?

Add Student 3
3 Student Info
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age*
Grade in School 2023-2024
Student email
Student Cell Phone

Area CodePhone Number
New or Returning Student?*

Returning StudentNew Student
Number of Years at Thornhill Learning Center
Full-Time Options
Part-Time Options
Summer Camp Availability*
Optional: Summer Camp Availability
Optional: Summer Camp Availability
Course Cost
Totals
Total Tuition
We will make any necessary corrections and bill your account. Payment and a current account is required to secure a place in each class. Class sizes limited.
Notes:
Terms and Conditions
Today's Date

MonthDayYear
Date
By checking 'I Agree' below and submitting this form, you, the Parent or Guardian of the above student(s), agree to release "Thornhill Learning Center", including instructors and assistants from liability for any and all injuries which may occur while training, practicing, performing, or during any center event or activity. You also agree that you are responsible for health and accident insurance and any medical costs incurred due to injury. You give permission for emergency medical transportation and treatment of your student(s) at your expense should the need arise. You also give your permission for the public display of any studio visual images that your child may appear in.
I Agree
Should be Empty:

Summer Camp Registration 2024

Parent/Guardian Info

Billing Info

Student Info

Student 2 Info

3 Student Info

Totals

Terms and Conditions