2018 SUMMER CAMP REGISTRATION FORM



TODAY’S DATE__________

CAMPER'S NAME______________________________________________HOME TELEPHONE___________________

HOME ADDRESS___________________________________________________________________________________
                                NO. AND STREET                        CITY/TOWN                                     STATE/ZIP CODE

MOTHER'S NAME_______________________WORK TEL._______________________CELL #___________________

FATHER'S NAME________________________WORK TEL._______________________CELL #___________________

EMAIL(S) ___________________________________ OTHER FAMILY MEMBERS____________________________

BIRTHDATE____________________SEX_______HGT_______WGT_______NATIONAL ORIGIN_________________

HAIR COLOR______________EYE COLOR_____________ALLERGIES______________________________________
THREE (3) PEOPLE TO CONTACT IN CASE OF EMERGENCY (NAME, ADDRESS, AND TELEPHONE)

1._______________________________________________________________________________________________

2._______________________________________________________________________________________________

3._______________________________________________________________________________________________

CHILD'S PEDIATRICIAN ______________________________________ TELEPHONE #_________________________

DATES ATTENDING: JUNE 25____ 26____ 27____ 28____ 29____.     JULY 2____ 3____(We are closed July 4th, 5th

& 6th).      JULY 9____ 10____ 11____ 12____ 13____.       JULY 16____ 17____ 18____ 19____ 20____.    

JULY 23____ 24____ 25____ 26____ 27____.       JULY 30____ 31____   AUGUST 1____ 2____ 3____.      

AUGUST 6____ 7____ 8____ 9____ 10____.        AUGUST 13____ 14____ 15____ 16____ 17____.  

AUGUST 20____ 21____ 22____ 23____ 24____.      AUGUST 27____ 28____ 29____ 30____ 31____.

TYPE OF DAYS:  FULL DAYS (9:00a.m. to 3:00p.m.)______ EXTENDED DAYS (7:00a.m. to 6:00p.m.)______ 

      UNLESS YOUR CHILD IS PRESENTLY ENROLLED IN DOLLY’S NURSERY SCHOOL OR OTHER FINANCIAL ARRANGEMENTS HAVE BEEN MADE WITH THE DIRECTOR, ALL CAMP FEES AND REGISTRATION FEES ARE DUE WITH YOUR REGISTRATION FORM. DAYS ENROLLED MAY BE “TRADED” FOR A DIFFERENT DAY IF SPACE IS AVAILABLE. NOTE: ALL CAMP FEES ARE NOT REFUNDABLE.  Camp fees for children currently enrolled in our preschool are due on June 1, 2018.

TOTAL FEES ______ X _____ + $50.00 = ______       FULL DAY rate is $67.00/day, FULL DAY rate for a 5 day week is $300.00/week. 
                     # OF DAYS     RATE             Reg. Fee     TOTAL FEES DUE  EXT. DAY rate is $82.00/day, EXT. DAY rate for a 5 day week is $375.00/week.

       A NON-REFUNDABLE REGISTRATION FEE OF $50.00 MUST ACCOMPANY THIS FORM TO RESERVE A SPACE FOR YOUR CHILD. NOTE: YOUR REGISTRATION FEE INCLUDES ONE COMPLIMENTARY CAMP T-SHIRT, TANK TOP, AND A CAMP BACKPACK. CAMP T-SHIRTS MUST BE WORN ON ALL FIELD TRIPS. ADDITIONAL SHIRTS MAY BE PURCHASED FOR $7.00 EACH. OPTION: IF YOU HAVE A BACK PACK FROM LAST SUMMER, YOU MAY PREFER TWO T-SHIRTS INSTEAD OF ANOTHER BACKPACK. JUST INDICATE "2" BELOW.  

T-SHIRT SIZE - SMALL (6-8) __________ MEDIUM (10-12) ___________   LARGE (14-16) ___________

NOTE: ALL CAMPERS MUST BE TOILET TRAINED. WE DO NOT HAVE DIAPERING FACILITIES

  

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