Summer Camp Enrollment Form

Summer Camp Registration

June 16th-20th | June 23rd-27th | June 30th-July 4th
Cost Per Week $350 | SCHOLARSHIPS MAY BE AVAILABLE |

Our Summer Enrichment Camp is the perfect opportunity for students who have completed kindergarten through 6th grade to engage in hands-on, multisensory learning. Each day is filled with exciting activities that inspire creativity, spark exploration, and foster discovery-all while making learning fun! Don’t miss out-reserve your spot today and ignite your child’s imagination and love for learning this summer!

Please mail check to:

The Pittsburgh New Church School

299 Le Roi Road

Pittsburgh, PA 15208

Be sure to indicate "summer camp" on the memo line. For other ways to pay please call the office. 412.731.0122
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade Completed*
Name of School*
Please Indicate which week or weeks your child will be attending:

June 16th-20thJune 23rd-27thJune 30th-July 3rd
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
MEDICAL INFORMATION
Physician Name

First NameLast Name
Phone Number
Insurance Provider

NameName of Policy Holder
Member IDGroup Number
Medical Concerns
Does your child have dyslexia or other learning challenges?
Emergency Contact

First NameLast Name
Phone Number
Should be Empty:

Summer Camp Registration