Form

Summer Camp Registration Form

Parent/Guardian full name*

Name and grade of first child as of Sept. 2010

Name and grade of second child as of Sept. 2010

Week desired

E-mail:*

Address:

City:

State:

Zip code:

Phone:

Cell phone/emergency contact

Allergies

Payment form

Credit Card Number

Expiration Date

A non-refundable deposit of 100.00 will be billed to your credit card and the balance is due 1 month prior to camp. By submitting this form you state you have read and agree to our policies and prices. You also agree to hold A Girl's Place harmless for any unlikely injuries that occur on our premises.