Half Day Registration .pdf

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Author: fitnessadv

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2016 Half Day Summer Registration
Family Name___________________________________________________________________________________________________________
Parent Name___________________________________________________________________________________________________________
Home Phone_______________________
Cell Phone__________________________
Email____________________________________________________________________________________________________________________
Mailing Address_______________________________________________________________________________________________________
City__________ Zip_________
Emergency Contact___________________________________________________________________________________________________
Emergency Contact Number_________________________________________________________________________________________
Student Name__________________________________________________________________________________________________________
DOB_______________
Gender: Male/Female
Special Needs__________________________________________________________________________________________________________
Please List All Food Allergies:
___________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________

Half Day registration includes 3 hours of gymnastics instruction at GymNation.
CHECK OFF SESSION AND DAYS YOU WOULD LIKE TO ATTEND.
Monday-Thursday 9:30am – 12:30pm.
*FOR EACH FULL WEEK OF CAMP BOOKED RECEIVE THE 5 TH DAY FREE!
1 DAY: $65
2 DAYS: $125
3 DAYS: $185
4 DAYS: $225
th
th
Week 1: July 11 – 14
____MON____TUE____WED____THURS
Amount_____
Week 2: July 18th – 21st
____MON____TUE____WED____THURS
Amount_____
th
th
Week 3: July 25 – 29
____MON____TUE____WED____THURS
Amount_____
Week 4: August 1st – 4th
____MON____TUE____WED____THURS
Amount_____
th
th
Week 5: August 8 – 11
____MON____TUE____WED____THURS
Amount_____
Week 6: August 15 th – 18th
____MON____TUE____WED____THURS
Amount_____
nd
th
Week 7: August 22 – 25
____MON____TUE____WED____THURS
Amount_____
Week 8: August 29th – Sept. 1st____MON____TUE____WED____THURS
Amount_____
Total Camp Registration:

Office Use Only:

5th DAY*
Week 1____
Week 2____
Week 3____
Week 4____
Week 5____
Week 6____
Week 7____
Week 8____

Total Amount_______

Please specify the amount you would like charged to your credit card. At least one week’s payment
required by July 5th.
MC
VISA
AMEX
DISCOVER
Card#_________________________________________________Exp.___/____
Name on Card: _______________________________________________
Signature____________________________________________________
*REGISTRATION FOR CAMP IS NON-TRANSFERABLE AND NON-REFUNDABLE. NO EXCEPTIONS.


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