Soft by CZl1jz5R

VIEWS: 0 PAGES: 1

									                                                                            CEP Summer Camp 2011 Registration Worksheet
Last Name:                                             Street:                                         Phone H:                          Email 1:


First Name(s):                                         City/Zip:                                       Phone C:                          Email 2:


                                                                             Week 1       Week 2         Week 3             Week 4              Total               Amount Due
                                                                             7/5 - 7/8   7/11 - 7/15    7/18 - 7/22        7/25 - 7/29          Weeks

Child's Name                  IEP?        Birth Date             Fulltime                                                                                 @$70.00

                                                             Before ESY                                                                                   @$52.50

                                                              After ESY                                                                                   @$35.00

Child's Name                  IEP?        Birth Date             Fulltime                                                                                 @$70.00

                                                             Before ESY                                                                                   @$52.50

                                                              After ESY                                                                                   @$35.00

Child's Name                  IEP?        Birth Date             Fulltime                                                                                 @$70.00

                                                             Before ESY                                                                                   @$52.50

                                                              After ESY                                                                                   @$35.00

Child's Name                  IEP?        Birth Date             Fulltime                                                                                 @$70.00

                                                             Before ESY                                                                                   @$52.50

                                                              After ESY                                                                                   @$35.00

Child's Name                  IEP?        Birth Date             Fulltime                                                                                 @$70.00

                                                             Before ESY                                                                                   @$52.50

                                                              After ESY                                                                                   @$35.00

                                                                                                                                             TOTAL DUE
Note: ESY = Extended School Year Summer Program offered by your school
      IEP? Information is for planning purposes and will be kept strictly confidential                                Due Now               Deposit/$25 per week

                                                                                                                      Due by July 5         Balance



       Rev. 1/27/10 ekt

								
To top