Broadway Gymnastics Summer Camp Registration 2008

Student Name_____________________________ Age___________

Address________________________________________________________

City__________________ State________ Zip Code___________

Home Phone #____________________

Mother __________________ Cell #___________ Work #___________

Father __________________ Cell #___________ Work #___________

Emergency Contact______________________ Phone #______________

Member? Yes No Level__________ Coach___________

All Stars (5 & up)$170/week $40/day Preschool (3-4) $120/week $25/day

8:30am-3:30pm 8:30am-12:00pm

$50 Non-Refundable Deposit is Required to Reserve a Space Each Week!

Circle Weeks Days Extended Care? (am/pm)

June 9-13 ______________ ____________________

June 16-20 ______________ ____________________

June 23-27 ______________ ____________________

July 7-11 ______________ ____________________

July 14-18 ______________ ____________________

July 28-Aug 1 ______________ ____________________

Aug 4-8 ______________ ____________________

Aug 11-15 ______________ ____________________

Front Desk Use Only

Total Due ________________

Less 7 wks Classes ($25) ________________

Less 4 wks Classes ($15) ________________

Less Multiple Child Disc. ($20) ________________

Less Multiple Camp Disc. ($20) ________________

Less Deposit ________________ cc_______ ck#______ cash_____

Balance Due 1^st day of camp ________________ cc_______ ck#______ cash_____

I understand that this is a non-refundable deposit to hold my child’s space in the above camp(s) above.

Parent Signature x_________________________________________