SummerBreak Camp Enrollment Agreement & Fee 2016January 20th, 2016
FiledJanuary 20th, 2016Please complete this form IN FULL for EACH child being enrolled. A $75.00 non-refundable fee is required per child.Price includes one SUMMERBREAK t-shirt which must be worn on all learning trips or on other events determined by staff. T-Shirt Size (please circle): Y-S Y-M Y-L A-S A-M A-L - Additional t-shirt is $15.00 Student Information: Date Received (for office use only) Date Enrollment fee Charged/Received (for office use only) Last Name First Name Middle Name Preferred Name Birthdate Gender (M or F) Grade Entering Enrolled at King’s yes no Parent/Guardian Information: Father/Step-Father/ Guardian (circle appropriate designation) Mother/Step/Mother/Guardian Home Street Address City State Zip