Enrollment Form

Camp Enrollment Form

This form is intended for School Year Day Camp and 2019 Summer Camp enrollment only. An enrollment form is needed PER child. Please fill out one form per child attending Camp. Sibling discounts will be applied to the youngest child's tuition use coupon code SIBDISC2019 at checkout.
Anticipated First Day of Attendance: *

Month Day Year
Date Date Picker Icon
Child's Name *

First Name Last Name
Name your child goes by: *
Gender *

Female Male
Child's Date of Birth *

Month Day Year
Date Date Picker Icon

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number- **WE WILL CALL THIS NUMBER FIRST** *

Area Code Phone Number
Email- must be one that you check frequently and can be reached by *
example@example.com
Days that your child will attend our program: (summer offers MWF or TWTh as 3 day option) *

DAY CAMP during school year 10 Week SUMMER CAMP: 2 day program: T/Th 10 Week SUMMER CAMP: 3 day program: T/ W/ Th 10 Week SUMMER CAMP: 3 day program: M/W/F 10 Week SUMMER CAMP: 5 day program: M-F SUMMER CAMP (choose your weeks): 5 days only
TUITION and FEES for Summer 2019

**Please Note**
Upon registration for Summer Camp, there are no make-ups or refunds.
Camp week transfers will be honored based on availability and enrollment numbers.

Summer 2019 10 week program: 9:10a-2:00p
- 2 days (T/Th): $498/mo
- 3 days (T-W-Th or MWF): $690/mo
- 5 days (M- F): $1025/mo
  - August Camp Tuition will be prorated.
  - Secure Summer enrollment by paying both of the following:
    
    FIRST month of Summer Tuition, this amount will be credited to your June tuition statement.
    
    Supply/ Activity fee $100
Weekly Camp Tuition:
$310/wk per camper (tuition, activity, and supply fee combined)
Secure Summer enrollment by submitting payment IN FULL at time of registration. CC payments at the bottom of this form. Cash or Check drop off in our office within 5 days of submitting this form.

Weekly Camp Extended Care fee: $150/week

Extended Program: 8:30a-5:30p *additional fee*
**Limited Availabilty**
- 2 day: $225/ mo
- 3 day: $265/ mo
- 5 day: $350/ mo
- Daily drop in fee (pending availability): $40/ day due at time of service
- Aftercare by the week: $150/ week *intended for weekly campers*
Sibling Discount:
- 1st child: full price
- Subsequent siblings: 10% off tuition- use coupon code SIBDISC2019 at check-out
- Codes used in error will result in a balance due before first day of camp.
Please select the weeks your child will attend during Summer 2019: ***note: there is no camp the week of July 1-5**

My child will attend ALL 10 weeks of Summer 2019 Week 1: June 3-7, Island Splash Week 2: June 10-14, Under the Sea Week 3: June 17-21, Pirates & Princesses Week 4: June 24-28, Dino Discovery Week 5: July 8-12, STEM Exploration: Imagine and Build Week 6: July 15-19, STEAM: Creation Station Week 7: July 22-26, Super Hero Training Week 8: July 29- Aug 2, Summer Camp Out: S'more Fun! Week 9: Aug 5-9, Neon Glow Party Week 10: Aug 12-16, Space Camp
Attendance Time Options: (choose one) *

9:10am-2pm: Regular Program Hours 8:30am- 5:30pm: Regular Program with added After-Care
Parent/ Guardian 1 *

First Name Last Name
Relationship to Child: *

Mother Father Guardian
Phone Number- Parent/ Guardian 1 *

Area Code Phone Number
Email- Parent/ Guardian 1 *
list an email checked frequently

Address if different from address listed for child

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent/ Guardian 2 *

First Name Last Name
Relationship to Child: *

Mother Father Guardian
Phone Number- Parent/ Guardian 2 *

Area Code Phone Number
Email- Parent/ Guardian 2 *
list an email checked frequently

Address if different from address listed for child

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Important information regarding your child:
Does your child have any medically diagnosed allergies? *

Yes No
Please include details about the medically diagnosed allergies listed above:
ex: Food/ Insect/ Environmental... Reaction type: ingestion/ contact/ proximity
Has your child experienced a significant life event that continues to effect their life? If Yes, please explain. If No, please type NA. *
Please list any serious illness/ injury or recent hospitalizations within the last 12 months. *
If no, please type NA
Child's Health: Please share any cognitive or physical disability, food intolerances, or any other important information regarding your child’s well-being. Sharing this information allows us to provide the best possible school environment for your child. *
Emergency Contact/ Authorized To Pick Up

Please list an ADULT that is permitted to pick up your child in the event you can not be reached or unable to pick up your child from school. This person must have a local address.
Emergency Contact... permitted to pick up child *

First Name Last Name

Emergency Contact- Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Emergency Contact- Phone Number *

Area Code Phone Number
My Time Kids Academy Withdrawl/ Program Drop Policy

***Please Note: Upon registration for Summer Camp, there are no make-ups or refunds. Camp transfer requests will be honored based on availablity and enrollment numbers. ***
By typing your name below- you agree to adhere to the policy above: *

First Name Last Name
PAYMENT OPTIONS
---Read the TWO payment options directions below carefully!---

Enrollment is not finalized without payment.
- Option 1 :
  Submit Summer Camp fees to My Time Kids via cash/check within 5 business days of submitting this form or your enrollment will no longer be vaild . Current MTK families deadline is April 19th.
  * STOP! DO NOT COMPLETE THE BOTTOM OF THIS FORM, scroll to the very end- click submit then swing by our office to make payment**
- Option 2 :
  Pay TODAY using a credit card or bank debit card. Continue on to the bottom of this form. Click submit when finished. **Credit card payments will incur a 3% processig fee, due by cash or check the fist day of camp.**
ONLY COMPLETE THE BOXES BELOW IF PAYING ONLINE RIGHT NOW.

You may pay by cash or check in our office. *Current MTK families may ask to be billed through our tuition software.*