Summer 2008 On-Line Enrollment Form

On-Line Enrollment Form

Please complete all required information. On-line enrollment is only available to customers wishing to make a credit card deposit.
CAMPER INFORMATION
First Name:
Last Name:
Gender: Male Female
Date of Birth: 2008-09 Grade:
/ /
PARENT/GUARDIAN INFORMATION
Parent 1:
Parent 2: (optional)
Mailing Address:
Street Address: (if different)
City/Town: State:
Zip Code: Home Phone:
Business Phone: Cell:
Email:
Would you like to get a free camp t-shirt by going Paperless? (By selecting yes, you agree to receive all correspondence via e-mail instead of postal mail.)     Yes    No
EMERGENCY CONTACT INFORMATION
Emergency Contact 1 Relationship:
Daytime Telephone: Alternate Telephone:

Emergency Contact 2 Relationship:
Daytime Telephone: Alternate Telephone:

Please select the weeks you would like to reserve:
(NOTE: A $50 discount may apply to your Week 1 enrollment.)
(You may change enrollment dates freely through 6/13. Weeks need not be consecutive. )

Week 1: June 30-July 3 Week 2: July 7-11
Week 3: July 14-18 Week 4: July 21-25
Week 5: July 28-Aug. 1 Week 6: Aug. 4-8
Week 7: Aug. 11-15 Week 8: Aug. 18-22
Week 9: Aug. 25-29
Are you opting for a 5-day week?
Yes
If no, please select the days your camper will attend.
Monday Tuesday Wednesday Thursday Friday
Are you enrolling this camper with a sibling?
Yes (Be sure to fill out seperate agreements.) No
Do you want door-to-door bus transportation?
(Remember, you will be billed an additional $60 per week for this service.)
Yes No
Will you opt for before or aftercare?
Remember, you will be billed $5/hour for this additional service.
Yes Drop-off time: Pick-up time:

No

DEPOSIT INFORMATION
(An enrollment is not valid unless a deposit has been made.) Full payment is now due. Please consult our pricing information or call 369-0440 for the amount that will be charged to your card.      
Mastercard       American Express       Visa       Discover
Card Number:
   
Expiration Date:
V-Code: (On back of card)
ENROLLMENT AGREEMENT
I agree to make full payment for this camper's enrollment at Apple Day Camp before 6/25/08, unless I request a refund in writing prior to this date. I accept responsibility for all fees and charges I may incur related to camp, including those applicable for late payment, session changes or returned checks. I agree to submit all required forms and information for this camper.

By clicking yes I, the above named parent, understand and consent entirely to this agreement.
Yes, I agree and consent to these terms. No.