MY GYM Children's Fitness Center

SUMMER CAMP Pre-Registration Form
June 6 - August 12, 2011
AM Camp: 9:00 AM - 12:00 PM
PM Camp: 1:00 PM - 4:00 PM

Camp Fee:
1 - 7 camp sessions: $29.00 ea.
8 - 15 camp sessions: $26.00 ea.
16 and more camp sessions: $22.00 ea.


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:
Any Allergies?
Register Additional Child? Yes No

Please select desired day(s):

	Monday	Tuesday	Wednesday	Thursday	Friday

June 2011

N/A

July 2011

N/A

August 2011

Number of Children: Number of Camps Selected: Total Cost: $ (including 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.