2 Year Old Form Pdf

SUMMER CAMP REGISTRATION 2009 June 30th – August 13th

NAME OF CHILD:__________________________________________

GENDER _______

AGE AS OF JUNE 29th: Years______ Months_______ PARENT NAME:___________________________________ ALT. PHONE:______________________ PARENT NAME:___________________________________ ALT. PHONE:______________________ ADDRESS:____________________________________________________________ HOME PHONE:____________________

E-MAIL ADDRESS: _________________________________

2 Year Old Program: ** Child must be 2 years old by June 30. 3 Day Program – Tuesday, Wednesday and Thursday - 9:00 – 12:00 noon (NO LUNCH) _______ SESSION 1 - $600

June 30 – July 23 (4 weeks)

_______ SESSION 2 - $450

July 28 – August 13 (3 weeks)

_______ SESSION 3 - $975

June 30 – August 13 (7 weeks)

TOTAL: ____________ Deposit: ____________ Balance Due: ________

• A $100 Non – Refundable deposit is required with the signed application. Please make checks payable to TSTI Preschool. Mail deposit to TSTI Iris Family Center, 432 Scotland Road, South Orange, N.J. 07079. Parent Signature: __________________________

Date: ______________