2019 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 24____ 25____ 26____ 27____ 28____.     JULY 1____ 2____ (We are closed July 3rd

4th & 5th).      JULY 8____ 9____ 10____ 11____ 12____.       JULY 15____ 16____ 17____ 18____ 19____.    

JULY 22____ 23____ 24____ 25____ 26____.       JULY 29____ 30____   31____ AUGUST 1____ 2____.      

AUGUST 5____ 6____ 7____ 8____ 9____.        AUGUST 12____ 13____ 14____ 15____ 16____.  

AUGUST 19____ 20____ 21____ 22____ 23____.

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 THE $50.00 REGISTRATION FEE ARE DUE WITH YOUR REGISTRATION FORM. NOTE: YOUR REGISTRATION FEE INCLUDES ONE COMPLIMENTARY CAMP T-SHIRT, AND TANK TOP. CAMP T-SHIRTS MUST BE WORN ON ALL FIELD TRIPS. ADDITIONAL SHIRTS MAY BE PURCHASED FOR $7.00 EACH.  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 15, 2019.

TOTAL FEES ______ X _____ + $50.00 = ____________             FULL DAY rate is $69.00/day, FULL DAY rate for a 5 day week is $310.00/week. 
               # OF DAYS            RATE         Reg. Fee     TOTAL FEES DUE             EXT. DAY rate is $84.00/day, EXT. DAY rate for a 5 day week is $385.00/week.

      
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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