Mosholu Montefiore Community Center ● 3450 Dekalb Avenue Bronx, NY 10467

(718) 882-4000 ●

Spring Break Trips!
School Vacation Trips, Kindergarten - Sixth Grade
Wednesday, April 11

CoCo Key Water Resort
Waterbury, CT
Indoor Water Park
Please send bathing suit and towel
Members: $45
Non-members: $49

Thursday, April 12

East Hanover, NJ
Members: $45
Non-members: $49

All participants must bring lunch. A snack will be provided.
Participants must be at The Center by 8am and picked up by 6pm or late fees of $20 for the
first 15 minutes and $1 for each additional minute will be charged. All trips subject to change.
Spring Break All Day Trips Registration Form 2012

Return in person to Mosholu Montefiore Community Center: 3450 Dekalb Ave. Bronx, NY 10467
Child’s Full Name_______________________________________________ Grade________ School_______________________________________________
Address______________________________________________________________________________________________Apt______ Zip________________
Mother’s Name________________________________________________ Cell Phone # __________________________ Work #________________________
Father’s Name ________________________________________________ Cell Phone # __________________________ Work # _______________________
Emergency Name & Phone # ________________________________________________________________________________________________________

Please check here ( ) for April 11 • Please check here ( ) for April 12
Total Member Amount Enclosed $_______ (Members have already paid the $245 Family Membership fee) Total Non-member Amount Enclosed $_______
I give permission for my child to participate in all activities and receive emergency medical care, if needed.
Unless we can replace your child for the trip, there will be no refunds.

Parent’s Signature____________________________________________________________________________________

Please indicate who is allowed to pick up your child


Please check here if you want
your child to walk home
_________________ initial

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