MY GYM Children's Fitness Center

SUMMER CAMP Pre-Registration Form
June 7 - August 13, 2010
AM Camp: 9:00 AM - 12:00 PM (Mondays only) and 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 2010

N/A

July 2010

August 2010

Returning Customers:

Number of Camps Selected: Total Cost: $ per child. (including quantity discount)

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.