enrollment application - Driftwood Day Camp

Not Available ... Circle Rate and Check Boxes Below As Needed ... EMERGENCY CONTACT NAME ... OUR WEBSITE OR FOR PUBLICITY PURPOSES. 5.
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2016

ENROLLMENT APPLICATION DISCOUNTED TUITION RATES VALID UNTIL 6/30/16. TUITION WILL INCREASE AS OF 7/1/16.

_____________________________

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CAMPER’S NAME

FATHER’S NAME

GENDER

__________________________________________________________________________ HOME ADDRESS

__________________________________________________________________________ WORK PHONE

__________________________________________________________________________ TOWN ZIPCODE

__________________________________________________________________________ CELL PHONE

__________________________________________________________________________ HOME PHONE NUMBER

__________________________________________________________________________ EMAIL ADDRESS

__________________________________________________________________________ DATE OF BIRTH (mm/dd/yy) AGE AS OF 6/16 GRADE AS OF 9/16 __________________________________________________________________________ EMERGENCY CONTACT NAME RELATIONSHIP __________________________________________________________________________ EMERGENCY PHONE

_____________________________ MOTHER’S NAME __________________________________________________________________________ WORK PHONE __________________________________________________________________________ CELL PHONE __________________________________________________________________________ EMAIL ADDRESS

Circle Rate and Check Boxes Below As Needed

PROGRAM

Grade as of September 2016

8 Weeks

6 Weeks

6/27 - 8/19

6/27 - 8/19 CIRCLE 6 OF 8

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1 2 3 4 5 6 7 8

4 Weeks FIRST 4

SECOND 4

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o

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Grades Pre-K, K

$6295 $6595

$5495 $5795

$4295 $4595

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Grades 1, 2, 3, 4, 5

$6695 $6995

$5795 $6095

$4495 $4795

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Grades 6, 7 – Pre-Teen Travel

$7495 $7795

$6695 $6995

$4995 $5295

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Grades 8, 9 – Teen Travel

$8295 $8595

Not Available

$5995 $6295

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Junior Counselor: Age 15 by 6/16

$2895 $3195

Not Available

Not Available

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Mini Week: (Pre-K & K) MON TUE WED

$5495 $5795

$5095 $5395

$4095 $4395

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Mini Week: (Grades 1 - 5) CIRCLE 3 MON TUE WED THU FRI

$5695 $5995

$5295 $5595

$4295 $4595

CIRCLE 3

THU

FRI

Extensions made after the first day of camp will be billed at the prevailing rate at the time of extension.

Tuition includes transportation, all activities, lunch, one camp shirt, camp bag, snacks, and towel service. DISCOUNTED RATES EXPIRE 6/30/16. PAYMENT RECEIVED AFTER 6/30/16 WILL BE BILLED AT POSTED RATES

DATE: DEPOSIT AMT:

FOR OFFICE USE ONLY DATE: PAYMENT AMT:

CAMP SESSION:

June 27 - August 19, Monday-Friday There will be no camp Monday, July 4th. Camp dates may be subject to change.

NOTES:

REGISTRATION DEPOSIT: $795.00

Please indicate preference for one MUTUAL grouping placement:_____________________________________________________________ Final placement is made at the discretion of the directors. We will try to honor your positive requests. Please indicate what school the camper will attend September 2016:__________________________________________________________ Please indicate the number of summers the camper has attended Driftwood Day Camp:_________________________________________ If a new camper, please indicate what camp your child went to p