Deerfield Community Center

Summer Day Camp – Program Application Form

 

First and Last Name of Child(ren) enrolling in Summer Day Camp:

Name:

Age:

1.

 

2.

 

 

Parent/Guardian Name:

GUARDIAN #1

 

GUARDIAN #2

 

 

Household Address (Street, City, zip):

 

 

Email Address:

 

 

Contact Phone Numbers:

NAME

Home:

Cell:

 

 

 

 

 

 

 

Employment of parent/guardian:

NAME

Name of Employer

Address

Phone

 

 

 

 

 

 

 

 

 

Dates of Attendance (Check each box that applies):

 

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

6/16-6/20

 

 

 

 

 

6/23-6/27

 

 

 

 

 

7/7-7/11

 

 

 

 

 

7/14-7/18

 

 

 

 

 

7/21-7/25

 

 

 

 

 

**Per day fee of $25/child or $35 for two children can be applied in place of signing up for whole weeks.

 

If your child is attending swimming lessons, which session(s) are they attending?

SESSION #1 (6/16-6/26)

 

SESSION #2 (7/7-7/17)

 

SESSION #3 (8/4-8/14)

 

**Discounted rates do not apply for Session #3.

 

Would you like to add on the $5/week per child ($25/child for all 5 weeks) fee to have lunch provided to your child?                                                   _______ Yes  _______No

 

Is your child going to be participating in Sunshine Club (Morning activities and Breakfast)?  The cost is $12/week per child.                                              _______ Yes  _______No