Learning Days Summer Fun Camp 2014

Registration Form (Ages 6-12)

Camp Dates: June 2-August 15
Cost: $100.00/Full-time or $60 for part-time (fieldtrip fees are not included)
Please complete this form and return to Learning Days no Later than May 2, 2014 to assure your
childs enrollment in our Summer Fun Camp. Summer Slots fill fast, so dont wait to return the form!

Childs Name_______________________________ Age__________

Childs Name_______________________________ Age__________
Parents Name______________________________ Wk#__________________
Address________________________ City, State, Zip______________________
Cell #___________________________ email_____________________________
List any Allergies or Health Problems____________________________________
In case of emergency my child must be taken to the following hospital:
__________________________________________________________________
Physicians Name___________________________ #_______________________
Your child will need the following supplies for Summer Camp: Scrap Book, Tennis shoes, (2) camp Tshirts, Sunscreen or sun hat, children may bring sports equipment for sports camp days, camera, Library
Card, Journal (spiral notebook) and bring bottle water/back pack for outdoor field trips. ** Learning
Days is not responsible for any lost items.

T-shirt Order (s) price $5.00/each

Child #1 Size_______ #___2___ Child #2 Size________ #__2___ Child #3 Size_______#__2___
_____I have included my t-shirt fees in the amount of $__________________.
____ I understand that all fieldtrip fees and camp supplies are due on or before June 2, 2014
____ I agree to give a 2 week notice in the event my child no longer needs to attend the camp
or I will be responsible for tuition until the end of the 2014 Summer Camp.

Parents Signature__________________________________ Date____________

If your family receives State assistance, please contact your caseworker by May 15, 2014 to change your
Child Care to Full-day for the Summer.