Thanksgiving 2019 Camp Registration

Student's Name *

First Name Last Name

Age *

Grade

School

List any allergies or medical conditions the school needs to be aware of

Will sibling also be attending? *

Yes No

Student's Name *

First Name Last Name

Age *

Grade

if applicable

School

List any allergies or medical conditions the school needs to be aware of

Parent's Name *

First Name Last Name

Contact Number *

Email *

Confirmation Email Invoices and other school notices are sent to emails on file

Address *

Street Address
Street Address Line 2
City
Zip Code	Country

Emergency Contact Name *

Same as above

Emergency Contact Number *

Same as above

Additional Comments/Notes

How did you hear about us?

Internet Search Driving By Facebook Friend Referral

I give my permission for my child's / my photo and artwork to be used in promotional material. Only first name, last initial and age will be used for credit line.

TUITION & FEES

Half Days $ 148.00

Sessions: Students:

Full Days $ 276.00

9:30 am - 3:30 pm — Students:

Sibling Discount $ -10.00

Enter coupon

Total $ 0.00

Payment Information
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

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Thanksgiving Camp Registration