SUMMER CAMP    Pre-Registration Form
June 9 - August 15, 2008
1:00 PM - 4:00 PM

CAMP FEE:
1 - 7 camp sessions: $30.00 ea.
8 - 15 camp sessions: $26.00 ea.
16 and more camp sessions: $22.00 ea.

NOTES:

• Your Camp registration can be used by any child in your household (potty-trained, 3 year old and older).
• Example: You may choose to purchase 10 camp sessions and have one child come 10 times or 2 children come 5 times, or any other combination.
• You are able to make changes to the dates that you've initially selected, as long as space is available in the camp you would like to switch to. A 24 hour (or more) notice is required to make changes. At the end of the Summer Camp session, any unused camp dates are not refundable and will be forfeited.
• If a camp date has to be cancelled by My Gym, you will have an opportunity to switch to another date, credit your My Gym account, or request a refund.

Parent or Guardian Information: Please fill out the information below:
Your First Name:
Your Last Name:
Your Street Address:
City, State, Zip Code:	,
Your Email Address:
Home Phone Number:
Cell Phone Number:
Notes / Comments:
First Child Information:
First Name:
Date of Birth:	Select Month January February March April May June July August September October November December   Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993
Any Alergies?
Register Additional Child?    Yes No

NOTE: If both children are being registered for exactly the same days/times, please use this form to make your selections. If the desired dates are different for each child, please submit a separate form instead.
Second Child Information:
First Name:
Date of Birth:	Select Month January February March April May June July August September October November December   Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993
Any Alergies?

Please select desired day(s):     (This schedule is preliminary and may be modified based on reaching enrollment minimums and facility availability) August 2008 Monday Tuesday Wednesday Thursday Friday 11 12 13 14 15   PM
Number of Camps Selected:           Total (per child) Cost:  $   (includes quantity discount)
Returning Customers:
If you know that we have your recent Credit Card information on file and you would like us to use it for payment, please enter the last 4 digits of your credit card number and the 3-digit CVN number, found on the back of the card. Providing this information authorizes My Gym to charge your Credit Card account for the camp fee.	Last 4 digits: CVN Number
NOTE: Submitting this PRE-REGISTRATION FORM does not automatically register your child. We will contact you to finalize your registration on a "first come - first served" basis. * Due to limited space, no refunds can be issued once the child is enrolled. Make-ups allowed only if space is available.