SUMMER CAMP 2015 Application Form

Space limited to 20 students

Child’s name_______________

(Please fill out a form for each child if you are enrolling siblings.)
Age _ _ Boy __ Girl __

Parent’s name ____________

Telephone ____________

Email ____________

Emergency contact __________

Emergency contact 2 __________

*PAYMENT *

Full day week (8-5pm) $449

$449 deposit required at sign up. For 2 and 3 week sessions: Balance must be paid in full before beginning camp. For 4 week sessions: 2 payments can be made: Bal due before last week. There is a 10 % surcharge for payments

Half Day week (8-1pm) $275

$275 deposit required at sign up. For 2 and 3 week sessions: Balance must be paid in full before beginning camp. For 4 week sessions: 2 payments can be made: Bal due before last week. There is a 10 % surcharge for payments

Discount – 10 % if paid in full by April 30th.

SESSION DATES: (circle sessions you want your child to attend)

Monday June 29 - Thurs July 2 (Pro rate for daily rate)

Monday July 6 - Friday July 10

Monday July 13 - Friday July 17

Monday July 20 - Friday July 24

Monday July 27 - Friday August 31

Monday August 17 – Friday august 21

Monday August 24 – Friday August28

Students must bring a bagged lunch from home. WMAC will be providing a light afternoon snack.

List any Food Allergies and dietary restrictions: ________________________________________________________________________

Program includes physical exercise, please list any physical restrictions: _____________________________________________*Please print this form, fill out all the information and mail or bring it completed with your payment to: WMAC 540 Atlantic Avenue Brooklyn NY 11217 718 855 9898

Checks should be made out to HappyKicks

WMAC will be taking Day trips to local parks and museum. By signing this application, you are agreeing to have your child leave the premise.

Parent’s signature ______________

Date __________________

WMAC registrar _________________