Session and Financial Agreement Form

Name of Participant:

Address:

Telephone: Cell Phone: Work Phone:

E-Mail: Fax:

Date of Birth:                 Age:

Social Security #                 T-Shirt Size:

 

Please put a check next to selected dates and fees as listed below:

Summer Sessions:  $2,800 per person per two-week session

Session I - June 25, 2017 to July 9, 2017
Session II - July 9, 2017 to July 23, 2017
Session III - July 23, 2017 to August 6, 2017
Session IV - August 6, 2017 to August 20, 2017

Fees:

Summer Camp Fee (Number of Sessions: x $2,800) = $
Transportation Fee (Optional) Transportation fee is $50 for transporting participant to OR from camp and $100 for transporting participant to AND from camp = $
Discount
5% discount for fees paid in full by March 15, 2017 =
$
SUMMER PROGRAM TOTAL DUE   =        $


DEPOSIT PAYABLE UPON REGISTRATION:

Summer Program
Number of Sessions: x $500.00 per two week session = $ Deposit

BALANCE DUE IN FULL BY MAY 15, 2017

Deposits are non-refundable. Fees less the deposit will be refunded if a participant withdraws prior to May 1, 2017.  All fees must be paid in full prior to a participant’s arrival.  Unless special arrangements are made with the Director prior to a participant’s scheduled arrival date, fees will not be refunded if a participant arrives after the start of a session, withdraws after May 1, 2017 or is requested to leave because of behavioral or health issues.

MEDICAL: Parent or guardians are responsible for all medical expense(s) of the camper.  Expenses for pre-existing condition(s) and medication(s) shall be pre-paid.  All medicines shall come with original prescription bottles.

MISCELLANEOUS: All clothing and personal items should have the participant’s name.


I HAVE READ AND AGREE TO COMPLY WITH THE CONDITIONS STATED ABOVE

Name (Parent/Guardian)
Date
Verification code:
Re-type verification code:
This is a security to check to ensure you are a human user.

 

 

Session and Financial Agreement Form