Bering Summer Camp

DO NOT use this form if you are applying for financial aid.

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Name(s) of children attending

Please choose which week(s) you would like your child(ren) to participate. Also, choose whether you would like your child(ren) to participate in the Full Day program or partial day. If you have any questions please call 713-526-1017.

Full 4 Week Program - Choose One

Morning (8am - 12pm, breakfast incl.) - $300.00 per childAfternoon (12pm - 4pm, lunch & snack incl.) - $300.00 per childFull Day (8am - 4pm, breakfast, lunch, snack incl.)- $600.00 per child

Week 1 - Choose One

Morning (Bible Study) - $75.00 per childAfternoon (Dance) - - $75.00 per childFull Day - $150.00 per child

Week 2 - Choose One

Morning (Arts & Crafts) - $75.00 per childAfternoon (Arts & Crafts) - - $75.00 per childFull Day - $150.00 per child

Week 3 - Choose One

Full Day Only (Peace Camp) - $185.00 per child

Week 4 - Choose One

Morning (Music & Fun) - $100.00 per childAfternoon (Music & Fun) - $100.00 per childFull Day - $200.00 per child

PAYMENT - Select Full Program or Individual Weeks

Full program 1/2 Day$300.00

# of children

Full Program - Full Day$600.00

# of children

Week 1 - 1/2 Day$75.00

# of children

Week 1 - Full Day$150.00

# of children

Week 2 - 1/2 Day$75.00

# of children

Week 2 - Full Day$150.00

# of children

Week 3 - Full Day Only$185.00

# of children

Week 4 - 1/2 Day$100.00

# of children

Week 4 - Full Day$200.00

# of children

Total $0.00