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WINTER BREAK CAMP    Pre-Registration Form
Monday, December 20 - Friday, December 31, 2010    9 am - 12 Noon,   1 pm - 4 pm
Camp Fee: $30.00 each

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:
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:
Last 4 digits: CVN Number    

First Child Information:
First Name:   
Date of Birth:       
Any Allergies?

Second Child Information: (Optional)
First Name:
Date of Birth:    
Any Allergies?
Please make your choice(s) from the available remaining days:

December 2009

 

Monday Tuesday Wednesday Thursday
28
  PM
29
  PM
30
   
31
AM  

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.

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