Event Reservation Form

Parent Information

Title

First Name

Last Name

Address

City

State

Zip

Phone

Tuition Details

Please choose from the following options

Tuition Option	Qty	Amount
Registration $100		100.00
Security Guard $250		250.00
Full 6 weeks full day paid in full $2000		2000.00
Full 6 weeks 1/2 day paid in full $1880		1880.00
Full 6 weeks full day first payment of 3 $667		667.00
Full 6 weeks 1/2 day first payment of 3 $627		627.00
Weekly rate full day $400		400.00
Weekly rate 1/2 day $375		375.00
Lunch full summer $220		220.00
Lunch weekly rate $40		40.00
Camp T-shirt $15		15.00
Total

Child Name

Payment Information

Please enter your credit card info. This amount will be charged upon submitting the form.

Total Amount

Card Number

Card Expiration

Security Code

Same as above

Name on Card

Billing Address

Zip Code