Arts and Movement Summer Camp Registration

Personal Information

Camper's First Name *

Camper's Last Name *

Birth date (mm/dd/yyyy) *

Gender

Male

Female

Parent/Guardian's First Name *

Parent/Guardian's Last Name *

Cell Phone Number

Parent/Guardian's First Name

Parent/Guardian's Last Name

Cell Phone Number

Mailing Address *

Address Line 2

City *

State *

Zip Code *

Home Phone Number *

Email Address *

We require a $50 deposit for each session you sign up for at the time of registration. Today, would you like to pay: *

Only a deposit (and mail in a check for the remaining balance by May 15, 2010), or

The entire balance.