REGISTRATION IS COMPLETE AFTER PAYMENT IS MADE THROUGH PAYPAL

Cost for the Afternoon Summer Camp is $250 per week

1. Fill out the form below to register.
2. After the form, you will be forwarded to PayPal for payment.
Registration Form for Afternoon Summer Camp (June 9 – August 22, 2008)
— REQUIRED —
How did you hear about us?
Print Ad
Word of mouth
Mailer
Brochure/Flyer
Attended Birthday Party
Other
Child’s Name: Returning Family
New Family
Child's Birthdate:
I am registering my child for
AFTERNOON CAMP from 1:00-4:00pm
for the following week/s:
Week of June 9-13
Week of June 16-20
Week of June 23-27
Week of June 30 – July 4
Week of July 7-11
Week of July 14-18
Week of July 21-25
Week of July 28 – August 1
Week of August 4-8
Week of August 11-15
Week of August 18-22		 Age (as of start of class):

* Note: We do not send confirmations. Please assume your first choice has been accepted unless we contact you prior to the start of classes.

Parent’s Name:
Home Address:
City/State:
Zip Code:
Home Phone Number:
Alternative Phone Number (Work/Cell/Other):
Emergency Contact & Phone Number:
Email Address:

Where is your child in preschool?

Would you like to learn more about our new AFTERNOON ART & MOVEMENT DROP-OFF CLASS for 3s and 4s? Classes held 1:00-3:00pm daily!  Yes No.

Liability Waiver
Must be AGREED to before your child participates in classes

Release Agreement: I understand that there are risks inherent in any type of physical activity, and that it is my responsibility to verify my child’s fitness to participate in any class at Jonah’s Treehouse,LLC. I agree that I, or an authorized guardian or caregiver, will remain with my child at all times while s/he participates in any Jonah’s Treehouse class. Should any injury occur while my child is participating in Jonah’s Treehouse classes, I hereby agree to hold Jonah’s Treehouse, LLC harmless for such injuries. I also agree that, as my child will be in close proximity to other adults and children, I will not bring my child to classes if she/he is ill; makeups can be arranged.

Date: