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**Register by March 30 for Discounted Rate** Lunch is included in 2012 Summer Camp Program the price! Wednesday, June 27 through Friday, August 24, 2012 Monday through Thursday 2012 Registration Form Camper’s Last Name Camper’s First Name Present Grade(2011-2012 school year) Home Address City State Present School Campers Date of Birth Any Restraining Orders Yes No If Yes, a copy is required Provide any personal information (allergies, behavioral medication, etc.) we need to know that will help with your child’s adjustment to camp:_______________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ CONTACT INFORMATION IN CASE OF AN EMERGENCY Mother/Guardian Father/Guardian Alternate Contact Name Address Home Phone Work Phone Cell Phone Email Address T-Shirt Size: Youth XS (4-5) S (6-8) M (10-12) L (14-16) Adult S M L XL Additional Shirts can be purchased at the Summer Camp Meeting. **Register by March 30 for Discounted Rate** IMPORTANT INFORMATION *Program fee for 2012 is $1,950.00; register before March 30 the fee is $1,750.00. *Program will be held at Piscataway High School from 7:00am to 6:30pm. *$100.00 non-refundable deposit is due at the time of registration. Final payment is due by May 24, 2012. *There are no make up days for absences or days missed. - Over - CAMP PERMISSION SLIPS Registration for 2012 camp constitutes permission for the Piscataway Summer Camp to take my child on local trips outside camp as part of the regular camp program. PICTURES Unless you inform us otherwise, camp registration includes permission for photographs to be taken. Piscataway Schools may utilize photographs in camp brochures, display photography or electronic media. If you do not want your child’s picture taken please check here EMERGENCY AND MEDICAL CARE In the event that you cannot be contacted in an emergency you hereby grant permission for Piscataway Summer Camp to bring your child to the emergency room. I also hereby give permission to the medical personnel selected by the camp director to provide routine healthcare. ACTIVITIES My child has permission to engage in all programmed camp activities, except as noted on the camper’s medical form. Piscataway Summer Camp is based on a 5 day per week, 8 ½ -week experience. TUITION REFUND POLICY & REDUCTION OF WEEKS No tuition will be refunded. There are no refunds for absences or withdrawals from camp. No allowance or credit will be issued for missed, cancelled or changed weeks. I understand that if I have not paid my child’s balance in full by the May 24, 2012, my child's enrollment is subject to cancellation. DISMISSAL OF CAMPER The camp reserves the right to dismiss any camper whose condition, conduct, influence, or behavior is deemed unsatisfactory or detrimental to the best interest of the camp, the camper or their fellow campers. PARENT SIGNATURE I hereby enroll my child with a deposit and this application for the number of weeks stated herein. I will adhere to the tuition payment policy and understand the camp refund policy ____________________________________________ ___________________________________ Parent Signature Date Tuition for 2012 - $1,950.00 **Register by March 30 for Discounted Rate of $1,750.00** TUITION: DEPOSIT $100.00 PAID IN FULL $__________________________ CHECK#________ VISA____ MC____ ACCOUNT#___________________________________________________EXP DATE______________ RETURN TO: Piscataway Community Education, 1515 Stelton Road, Piscataway, NJ 08854 2nd Child (732) 572-4688 Office use only (please check) First Come, First Served Date Received: Lunch is included in the _________________ price! Monday through Thursday Lunch is included in the PISCATAWAY TOWNSHIP SCHOOLS price! 2012 Summer Camp Program Monday through Thursday Toddler to Eighth Grade The Piscataway 2012 Summer Camp Program provides children with an active, fun-filled learning environment that combines morning enrichment classes, afternoon recreation including swimming, day trips, and indoor and outdoor experiences. Certified teachers, teaching assistants, and trained counselors supervise the program. Program Location The toddler (18 month) to eighth grade camp program will be held at Piscataway High School, Doors #29 and #30 in the East Wing. Program Dates The program will operate from Wednesday, June 27, through Friday, August 24, for a total of 8 1/2weeks. Hours of Operation The program will operate from 7:00 a.m. until 6:30 p.m. It will be the responsibility of the parent or guardian to pick-up their child by 6:30 p.m. A late fee of $10.00 per 15 minutes will be charged at pick up time for campers picked up after 6:30 p.m. ***Food - We are providing lunch!*** Monday through Thursday Students will receive a nutritious lunch Monday through Thursday with a choice of hot or cold food ranging from sandwiches, to spaghetti or pizza. Students are only responsible for providing their own lunch on Fridays. Parents should still pack water and snacks daily. Clothing Students should wear comfortable clothes and bring a gym bag with swimsuit and towel on swim days. Each student will be given a camp shirt to be worn on field trips. Field Trips Field trips are conducted frequently and parents are given advance notice of trips. There are no additional costs for the trips. Some field trips being considered for this summer are: Funtown Pier Seaside, Dorney Park, Kids Village, and Waterparks just to name a few. Not all grade levels go on the same trips. Trips are planned in accordance to the child’s age level. Fees The all-inclusive fee for the Piscataway Summer Camp 8 ½ -week program is $1,950.00. If you register before March 30 the discounted fee is $1,750.00. This includes field trips. An additional fee is charged if children are picked up after 6:30 p.m. from the program. Registration The registration fee is $100.00 per child due at time of registration. This non-refundable fee is deductible from the total cost and must accompany the application form. It is recommended that registration be in person at the Administration Building from 8:00 a.m. to 4:00 p.m. You may pay the tuition in installments, but tuition must be paid in full by May 24, 2012. Returned checks from the bank will be charged a $30.00 service fee.
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