Real Life Day Camp Registration Form

Real Life Day Camp Registration Form 2013

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Camper Information

Last Name:	First Name:
Address:	City: State: Zip:
DOB: / / Sex:	Home Phone: () -

Mother Information

First Name:	Last Name:	Cell: () -
Place of Employment:		Work: () -

Father Information

First Name:	Last Name:	Cell: () -
Place of Employment:		Work: () -

Additional Information

Any problem areas in the camper's life of which the directors should be aware? (If yes, please explain):

How did you first learn about our camp?

List anyone other than a parent to whom your child may be released:

Name: Phone: () -
Name: Phone: () -
Name: Phone: () -

To register your child, please check the box of each day they will be attending camp. Days that he or she will not be attending, please leave blank.

There is a Deposit Fee required of $5.00 per day. This deposit will be deducted from the total amount due for that week. To calculate your required deposit, simply multiply the number of days your child will be attending by $5.00. (The electronic calendar below can calculate your deposit for you. After checking the boxes, click the "Calculate my Deposit!" button below the calendar).

The Registration Fee (separate from the deposit) is $25.00 per child, per summer. To register your child for Summer Camp the registration and deposit fees must be paid in full and mailed with this registration form. Make checks payable to Real Life Day Camp and Farm.

**Registration Fees Are NON-Refundable**

**Deposit Fees Are NON Refundable and NON Transferable After May 19, 2013**

MINIMUM ENROLLMENT IS 2 DAYS PER WEEK

**Days with a red background are currently full.**
You may still register for these days and be placed on a waiting list if you wish.

Week	Monday	Tuesday	Wednesday	Thursday	Friday
6/17 - 6/21
6/24 - 6/28
7/1 - 7/5				CLOSED	CLOSED
7/8 - 7/12
7/15 - 7/19
7/22 - 7/26
7/29 - 8/2
8/5 - 8/9
8/12 - 8/16
8/19 - 8/23

Math and Reading Camp
To register your camper for our Math and Reading Camp please fill out the form below.
Math and Reading Camp is an excellent way to let your child enjoy the farm all summer while keeping their math and reading skills tuned for the coming school year.
Campers will be split into two age groups: Grades 1-3 and Grades 4-6 (completed this past school year. The younger grades will meet from 1:30 - 2:30 and the older grades from 2:30 - 3:30. Each sesson is taught by a certified teacher with no more than 10 children per session. The time will include both independent activities and whole group activites.
Cost is $20.00 per session plus a $10.00 supply fee. At the time of registration a $5.00 per session deposit and the supply fee are due.

YES! I would like to sign my camper up for Math and Reading Camp!
No thank you. My child will NOT attend Math and Reading Camp.

The last grade my camper completed was:

Week of	MONDAY Math Camp	WEDNESDAY Reading Camp
6/17 - 6/21
6/24 - 6/28
7/1 - 7/5	CLOSED	CLOSED
7/8 - 7/12
7/15 - 7/19
7/22 - 7/26
7/29 - 8/2
8/5 - 8/9
8/12 - 8/16
8/19 - 8/23