Children Summer Camp Enrollment Week 5
July 13th- July 15th || 2nd week only || For 1 child 20$ per week, If more then 1 child pay $15 per child per week. Enrollment in SummerCamp is week to week basis
How Many Children You want to enroll
*
Student Name 1
*
First Name
Last Name
Student Name 2
*
First Name
Last Name
Student Name 3
*
First Name
Last Name
Student Name 4
*
First Name
Last Name
Student Name 5
*
First Name
Last Name
Father Name
*
First Name
Last Name
Mother Name
*
First Name
Last Name
Age group for student 1
*
4-6 years old
7-9 years old
10-12 years old
Age group for student 2
*
4-6 years old
7-9 years old
10-12 years old
Age group for student 3
*
4-6 years old
7-9 years old
10-12 years old
Age group for student 4
*
4-6 years old
7-9 years old
10-12 years old
Age group for student 5
*
4-6 years old
7-9 years old
10-12 years old
Gender for student 1
*
Please Select
Male
Female
N/A
Gender for student 2
*
Please Select
Male
Female
N/A
Gender for student 3
*
Please Select
Male
Female
N/A
Gender for student 4
*
Please Select
Male
Female
N/A
Gender for student 5
*
Please Select
Male
Female
N/A
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent E-mail
*
example@example.com
Payment
*
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( X )
For 1 Child
Pay for One Week Only
$20.00
$
20.00
Quantity
1
For 2 Children
$30.00
$
30.00
Quantity
1
For 3 Children
$45.00
$
45.00
Quantity
1
For 4 Children
$60.00
$
60.00
Quantity
1
For 5 Children
$75.00
$
75.00
Quantity
1
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