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
Camper Name
1st Parent/Guardian Name
2nd Parent/Guardian Name
Camper Sex
Choose
Male
Female
Camper Age
Choose
5
6
7
8
9
10
11
12
13
Camper T-Shirt Size
Choose
Child Small
Child Medium
Child Large
Child XLarge
Adult Small
Adult Medium
Adult Large
Adult XLarge
Day Phone
Evening Phone
Cell Phone
Email Address*
*This form cannot be submitted without a valid email address.
Select Camp Dates
Fee Chart
Number of Weeks Attending
Full Payment by January 1
Full Payment by April 1
Full Payment by June 1
All Payments after June 1
20% Discount
15% Discount
10% Discount
Full Amount
1 Week
$240
$255
$270
$300
2 Weeks
$480
$510
$540
$600
3 Weeks
$720
$765
$810
$900
4 Weeks
$960
$1,020
$1,080
$1,200
5 Weeks
$1,200
$1,275
$1,350
$1,500
6 Weeks
$1,440
$1,530
$1,620
$1,800
7 Weeks
$1,680
$1,785
$1,890
$2,100
8 Weeks *
$1,820 *
$1,940 *
$2,060 *
$2,300 *
* This total reflects an additional $100 off if you register for all 8 weeks.
Total Savings for all 8 Weeks
$580.00
$460.00
$340.00
$100.00
Additional Fees
Pre-Camp $250/wk or $50/day
AM Option $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.
PM Option
Costumes
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.
Additional Discounts
* 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.
Take an additional $100 off the total registration for returning campers (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 $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.
Take an additional $25 off
Please type in your payment total amount due to confirm your registration.
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 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.
VISA/Mastercard #
Name on Credit Card
Credit Card Expiration Date
Month
1 January
2 February
3 March
4 April
5 May
6 June
7 July
8 August
9 September
10 October
11 November
12 December
Year
2013
2014
2015
2016
2017
2018
2019
2020
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,
Billing Address*
City*
State*
Zip*
Please tell us where you heard about us.
Newspaper Camp Guide
Newspaper Ad - Inquirer/Daily News
Newspaper Ad - Chestnut Hill Local
Metro Kids
Web Search
Camp Postcard
Camp Fair
Email Announcement
From a Friend
Other: Please list in the Comments Section
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