

| Campers Name: |
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| Phone: | Bus. Phone: | |
| Email: | ||
| Any condition requiring attention: (allergies, etc.) |
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| I authorize emergency medical treatment and/or hospitalization if necessary for this camper. (typed/signed name signifies authorization)Parent/Guardian Signature: | ||
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Wk 1 2 3 4 5 6 7 8 9 AC |
| Chk # ______________ |
| Deposit ____________ |
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Cam Inst ___________ SCH |
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TK STAFF CIT CON HCIT HCON |
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FEE ________________ DEP _______________ BAL _______________ INST _______________ AA ________________ P _________________ T-S ________________ LT _________________ Total _______________ |
| MUSIC WEEKS (Sunday to Sunday) - I wish to enroll for the following: | ||
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WEEK 1 ........... MAY 26 - JUNE 2 WEEK 2 ........... JUNE 2- JUNE 9 WEEK 3 ........... JUNE 9 - JUNE 16 |
WEEK 4 ........... JUNE 16 - JUNE 23 WEEK 5 ........... JUNE 23 - JUNE 30 WEEK 6 ........... JUNE 30- JULY 7 |
WEEK 7 ........... JULY 7 - JULY 14 WEEK 8 ........... JULY 14 - JULY 21 WEEK 9 ........... JULY 21 - July 28 |
| ART WEEKS (Sunday to Sunday) - I wish to enroll for the following: | CHESS WEEK (Sunday to Sunday) | |
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WEEK 1 ........... MAY 26 - JUNE 2 WEEK 2 ........... JUNE 2 - JUNE 9 |
WEEK 4 ........... JUNE 16 - JUNE 23 WEEK 5 ........... JUNE 23 - JUNE 30 |
WEEK 3 ........... JUNE 9 - JUNE 16 |
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Art Camp - Art Material fee $35 per week
Chess Camp - Novice Intermediate Advanced Music Camp - instrument rental from camp - $25 per wk |
| Instrument I will play: *(never played an instrument)
Beginner* Intermediate Advanced |
I am interested in Transfer class ( Piano Guitar Band Orchestra) |
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If person not designated here takes children home or away from camp, they must sign out in the office.
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DEPOSIT FEE: ONE WEEK $200, TWO WEEKS $400 WILL SECURE REGISTRATION One Half of this deposit will be refunded if you do not attend camp. |