Zion Lutheran School – 2012 Summer Day Camp
Enrollment Form
Thank you for registering your child to attend Zion’s summer camp. Please indicate on this form the days you wish your child to attend for each session and turn in to the school office. The deposit for each week is due when you register. The remainder due for each session is to be paid by the first day your child attends for that week. Extended care will be billed. Thank you.
Half Day Full Day
8:00AM – 11:00AM 8:00AM – 3:00PM
$10.50/day-$52.50/week $20.50/day - $102.50/week
$10 non-refundable deposit $25 non-refundable deposit
Session Fees must be paid in full on or before the first day the child attends of each session.
Child’s Name: ______Nickname: ______Gender: M F
Birth Date: ______Grade in Fall: _____ Person Responsible for Fees: ______
Billing Address: ______City: ______Zip: ______
Mother’s Name: ______Email: ______
Phone: (H) ______(W) ______(C) ______
Father’s Name: ______Email: ______
Phone: (H) ______(W) ______(C) ______
Student lives with: _____both parents _____mother _____father _____other: ______
Who referred you/how did you hear about Zion’s Summer Camp? ______
My child will be in the Junior/Elementary camp. (Please circle)
Will you use Early Stay? (6:30am-8:00am) ______Will you use Late Stay? (3:00pm-6:00pm) ______
______Session 1 May 29th - June 1st ____Half ____Full ____Week
May 28th - closed T W TH F
# days x $10.50 = ______
# days x $20.50 = ______
less deposit ______
Total Due by May 29th ______
______Session 2 June 4th – 8th ____Half ____Full ____Week
M T W TH F
# days x $10.50 = ______
# days x $20.50 = ______
less deposit ______
Total Due by June 4th ______
______Session 3 June 11th–15th* VBS ____Half ____Full ____Week
M T W TH F
# days x $5.25 = ______
# days x $10.25 = ______
less deposit ______
Total Due by June 11th ______
(only pay if your child will be in summer camp after VBS)
______Session 4 June 18th – 22nd ____Half ____Full ____Week
M T W TH F
# days x $10.50 = ______
# days x $20.50 = ______
less deposit ______
Total Due by June 18th ______
______Session 5 June 25th – 29th ____Half ____Full ____Week
M T W TH F
# days x $10.50 = ______
# days x $20.50 = ______
less deposit ______
Total Due by June 25th ______
______Session 6 July 2nd – 6th ____Half ____Full ____Week
M T July 4th - closed TH F
# days x $10.50 = ______
# days x $20.50 = ______
less deposit ______
Total Due by July 2nd ______
______Session 7 July 9th – 13th ____Half ____Full ____Week
M T W TH F
# days x $10.50 = ______
# days x $20.50 = ______
less deposit ______
Total Due by July 9th ______
______Session 8 July 16th – 20th ____Half ____Full ____Week
M T W TH F
# days x $10.50 = ______
# days x $20.50 = ______
less deposit ______
Total Due by July 16th ______
_____Session 9 July 23rd – 27th ____Half ____Full ____Week
M T W TH F
# days x $10.50 = ______
# days x $20.50 = ______
less deposit ______
Total Due by July 23rd ______
______Session 10 July 30th - Aug. 3rd ____Half ____Full ____Week
M T W TH F
# days x $10.50 = ______
# days x $20.50 = ______
less deposit ______
Total Due by July 30th ______