Summer Camp Fees and Registration – Complete registration form for each child and return to the Recreation Department.

Fees: If you are registering more than one child for any combination of programs, the 2^nd will receive the sibling discount on any program, with the exception of Kiddie Kamp.
Kiddie Kamp - $38 per week – Must sign up on a weekly basis
*Week 2 (Short week) $30

Summer Playground - $55 per week - $50 for 2^nd child - $45 each additional sibling
$25 per day

*Week 2 (Short Week) $47 per week - $42 for 2^nd child - $37 each additional sibling
Teen Adventure - $55 per week \ $50 for 2^nd child - $45 each additional sibling $25 per day
*Week 2 (Short Week) $47 per week - $42 for 2^nd child - $37 each additional sibling

Playground Plus - $100 per week - $95 2^nd child - $90 each additional sibling $30 per day
*Week 2 (Short Week) $90 / $85 2^nd child\ $75 each additional sibling

Camp Weeks Camp Fee Weekly Total

*Week 1 - June 17 - June 20 $_______ $ ______
Week 2 – June 23 – June 27 $_______ $ ______
*Week 3 – June 30 – July 3) $_______ $ ______
(No camp July 4)
Week 4 - July 7 – 11 $_______ $ ______
Week 5 - July 14 – 18 $_______ $ ______
Week 6 - July 21 – July 25 $_______ $ ______
Week 7 – July 28 – Aug 1 $_______ $ ______
Week 8 – Aug. 4 – 8 $_______ $ ______
Week 9 – Aug. 11 – 15 $_______ $ ______

Please print clearly.

Child’s Name:____________________________________ Grade Fall 2003____________ Age ______

Address: _________________________________________________Home Phone ________________

Parent’s Names _______________________ Mom's Work # ____________ Dad's Work # ___________

Child's Physician ________________________________________ Phone # ______________________

List any Medical conditions\allergies: _____________________________________________________

In case of an emergency, may we transport via ambulance? Please circle Yes No

Please list anyone who does not have permission to pick up your child (If this is a biological parent, a copy of the court order must accompany this form). ______________________________________________

My child is in good health and has my permission to participate in this program and on field trips. I understand that various activities during camp present a risk of injury.

______________________________________________

Parent/Guardians Signature