2021 SUMMER CAMP/SUMMER PRESCHOOL REGISTRATION

[Pages:1]2021 SUMMER CAMP/SUMMER PRESCHOOL REGISTRATION

THE CHILDREN'S HOUSE - WWW.

Child's Name Age Address

Birth Date

Mother/Guardian's Name Business Name Phone#

Father/Guardian's Name Business Name Phone#

Emergency Contact Phone#

Doctor

Allergies

Business Address Cell# Business Address Cell# Cell#

Email

Work# Email

Work#

Email

Work#

Phone

Male Zip

Female

WEEKS TO ATTEND

Session I 6/07 to 6/11 6/14 to 6/18 6/21 to 6/25 6/28 to 7/02 7/05 to 7/09

Add extended day

Session II 7/12 to 7/16 7/19 to 7/23 7/26 to 7/30 8/02 to 8/06 8/09 to 8/13

Add extended day

PAYMENT OPTIONS

Pay in full - $160 per week $190 per week with extended day. Pay for all selected weeks by April 11 and save $10.

Pay weekly - $170 per week $200 per week with extended day. Weekly payments due by the preceding Monday.

A non-refundable $25 registration fee and $50 per week deposit must accompany this application and will hold your place for camp. There are no make-up dates or refunds for occasional absences. Mail or drop off the registration fee and application at The Children's House, 2404 W. 62nd. St. Indianapolis, IN 46268.

Extended day (7:00 AM to 5:45 PM) is an additional $30/week. You must check off the boxes above for any week you intend to use extended care.

If Summer Camp 2021 is cancelled due to COVID positivity rates being too high to safely bring children together, we will refund your $50 weekly deposits, and any other camp fees paid ahead.

AUTHORIZATION

I hereby give consent on behalf of my child/dependent to attend The Children's House Day Camp. I know of no reason why my child might not be able to participate freely in the activities for which they are enrolled. I give permission for my child to attend any excursions and/or field trips while enrolled in the summer camp.

Mother/Guardian Signature

Date

Father/Guardian Signature

Date

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