Once you have enrolled your child in our camp, you will need to print out, complete and return this camp health form to the camp staff.
• Camp Health Form
Camper and Parent/Guardian Information
1st Parent/Guardian Name
2nd Parent/Guardian Name
Camper T-Shirt Size
(+ area code)
(+ area code)
(+ area code)
Email Address *
*This form cannot be submitted without a valid email address.
Select Camp Dates
Number of Weeks Attending
Full Payment by January 1
Full Payment by April 1
Full Payment by June 1
All Payments after June 1
8 Weeks *
* This total reflects an additional $100 off if you register for all 8 weeks.
Total Savings for all 8 Weeks
$250/wk or $50/day
$45/wk or $10/day $90/wk or $20/day
The late fee for picking up your child after 6:00pm is $10 for every 5 minutes you are late in picking up your child after 6:00pm.
There is an additional $25 costume fee for those campers who will participate in our final week theater production. This fee is to be paid directly to the camp office at the beginning of week 5.
You automatically get $100 off the total registration for campers registered for all 8 weeks. You do not need to subtract this $100 from your total.
the total registration for returning campers from the previous year (must be the same camper). You must check this in order to receive this discount. You must have at least a 2 week registration to receive this discount.
Take an additional $100 off
Take an additional $150 off the total registration of a second camper from the same household. Separate registrations are required for each additional camper. Once you submit your first camper, you will be presented with a link to make an additional registration. This discount is only applied to the second registration. You must have at least a 2 week registration for both campers to receive this discount.
the total registration campers who have a parent/guardian in active military duty. You must have at least a 2 week registration to receive this discount.
Take an additional $25 off
Please type in your payment
total amount due to confirm your registration.
(Total = camp fees + pre-camp fees + before/after care fees - special discounts)
Coupon Code (Type in your coupon code - does not automatically deduct - discount will be activated before your card is charged)
Please type in the amount you want to pay once you submit this registration. The balance will be due prior to the start of camp.
A ll fees must be paid in full by no later than the first day of the start of your child's camp. Failure to make full payment may result in your child's inability to attend camp .
The deposit will reserve a space until
Check here if you wish to ONLY make a $100 NON_REFUNDABLE DEPOSIT at this time (for EACH camper). Otherwise the full amount will be charged to your credit card for the weeks that you have chosen. This $100 deposit does not grant you the discount price at the time of your registration. Total must be paid in full by the designated deadline to receive the discount. June 1, 2014. This deposit will be applied toward fees. After June 1, each week added to initial registration will cost $300, and for each week subtracted from initial registration, a $50 per week refund will be given. If you do not check this box, your current payment total will be charged to your credit card.
Allens Lane Art Center accepts Visa, Mastercard and Discover for payments through this website.
Name on Credit Card
Credit Card Expiration Date
Security Code (3 or 4 digit code on the back of the card)
*In order to make a payment using your debit/credit card from this form,
you must fill out your entire billing address below.
Billing Address *
Please tell us where you heard about us.
Newspaper Camp Guide
Newspaper Ad - Inquirer/Daily News
Newspaper Ad - Chestnut Hill Local
From a Friend
Other: Please list in the Comments Section
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