Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
0Activity
0 of .
Results for:
No results containing your search query
P. 1
Camp Whitehall Cementon Resident Registration

Camp Whitehall Cementon Resident Registration

Ratings: (0)|Views: 1 |Likes:
Published by Bill Landauer

More info:

Published by: Bill Landauer on Apr 12, 2013
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

04/12/2013

pdf

text

original

 
CAMP CEMENTON
(Completed Grade K—3 in June 2013)
CAMPER’S NAME (Last) (First) (MI) ADDRESS (Street) (City)BIRTHDATE
 / /
SCHOOL ATTENDED
GRADE COMPLETEDIN JUNE 2012
MOTHER’S/GUARDIAN’S NAME (Last) (First) (MI) ADDRESS (Street) (City)HOME PHONE DAYTIME PHONE CELL EMAIL*FATHER’S/GUARDIAN’S NAME (Last) (First) (MI) ADDRESS (Street) (City)HOME PHONE *DAYTIME PHONE *CELL *EMAILIF PARENTS CANNOT BE REACHED NOTIFY (Last) (First)CITY PHONE RELATIONSHIP
 ARE YOU INTERESTED IN SWIM LESSONS? (PRICE:
$35.00 PER SESSION
)
 YES NO
IF YES, WHICH SESSION?
SESSION I (June 24th-July 5th) SESSION II (July 8th-July 19th)
 YOUTH MED YOUTH LARGE ADULT SM
WHAT SIZE T-SHIRT WOULD YOU LIKE?(Additional shirts may be purchased for
$10.00
each)
 ADULT MED ADULT LARGE ADULT XL
 
TRANSPORTATION INFORMATION
DOES YOUR CHILD NEED BUS TRANSPORTATION TO GET TO/FROM CAMP? YES ___ NO ___ IF YES, PLEASE LIST BUS STOP.
PICKUP DROPOFF
***CHOOSE FROM THE FOLLOWING SESSIONS***
√ 
 
√ 
 
Week 1 (06/24-06/28) $90.00 Week 5 (07/22-07/26) $90.00Week 2 (07/01-07/05) $80.00 Week 6 (07/29-08/02)
 
$95.00
Week 3 (07/08-07/12) $90.00 Week 7 (08/05-08/09) $90.00Week 4 (07/15-07/19)
$105.00
Week 8 (08/12-08/16) $90.00
***Please note any extra charges for weekly payments (in bold) are to helpdefray the cost of the field trip that week***
NO SLOTS HELD WITHOUT PAYMENT. PAYMENT SECURES RESERVATION.PLEASE NOTE: THIS IS A 2-SIDED FORM. PLEASE FILL IN THE REVERSE SIDE!
 
PAYMENT INFORMATION
Cash or checks only. Please make checks payable to “Whitehall Township.” See “Guidelines for Parents” in your information packet for refund policies.By signing below, you are agreeing to all policies set forth by Whitehall Township and the Camp Whitehall Program.
If your child is removed from the program for disciplinary reasons, NO REFUNDS OR CREDITS will be issued for the remainder of the program.
 
SIGNATURE DATE
CAMP: .00 SWIM LESSONS: .00
TOTAL: .00

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->