Heritage Camp Registration

Heritage Camp Registration
To Register your Child and Pay Online, Click Here to use a Separate Form.
Part 1 - Parent or Guardian Information
Date of Registration

MonthDayYear
Parent or Guardian Full Name

PrefixFirst NameLast NameSuffix
Parent's E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Number

Area CodePhone Number
Alternate Phone Number (Job, House, Cell Phone)

Area CodePhone Number
Emergency Contact Name

First NameLast Name
Emergency Contact

Area CodePhone Number
Relationship to Child
Part 2 - Child Information
Full Name

First NameMiddle NameLast NameSuffix
Male or Female
Birth Date

MonthDayYear
Age
Grade Child will be Enrolling in September
Special Needs, Allergies, or Information:
Additional Child Registration (2nd Child)
Full Name

First NameMiddle NameLast NameSuffix
Male or Female
Birth Date

MonthDayYear
Age
Grade Child will be Enrolling in September
Special Needs, Allergies, or Information:
Part 3 - Session Registration
Registration Fee ($150) is per child, per week. Extended Day Care ($60) is per Family.
Week Sessions:
Registration for # of Children:
Extended Day Care Selection (Optional):
Payment Selection:
Mail Check or Money Orders to:

Heritage Education Group
ATTN: Heritage Camp
112 Harvard Ave. #124
Claremont, CA 91711
Should be Empty: