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Summer Days Camp begins June 4th

Summer Days Camp On-line Registration

 

Please fill out the form below and submit. One of our MAGIC team members will contact you shortly to confirm availability.

Previously enrolled at MAGIC
Yes No  
Child’s Name
Birth date
/ /   Age Sex M F
School and/or
current program		    
Primary Email Address* * required
Home Address
Apt#
City State Zip
Mother's Name
E-mail
Home Phone Work   Cell
Father's Name
E-mail
Home Phone Work Cell
Alternate Address
Emergency Contact    
Phone Cell
Physician's Name
Phone
Participating adult and/or person authorized to pick up child
Known allergies/Physical limitations
What's the best way for us to contact you?
Mother's Email Mother's Phone
Father's Email Father's Phone
Other
Please tell us how you heard about our program
Friend Web Site
NY Family Attended a Birthday Party
Epiphany Community Nursery School Other
       
PLEASE CHECK APPROPRIATE BOXES
Does your child take any medications regularly?
Yes No  
Name of medication, dosage
Condition medication is for
Are there any allergies or health conditions that we should be aware of?
Yes No  
If yes, please describe
Eyeglasses
(Should they be worn during their lessons?)
Yes No  
Contact lenses
(Should they be worn during their lessons?)
Yes No  
Dental Appliances
Yes No  
If yes, please describe
Hearing Aids
Yes No  
Please list any physical conditions we should be aware of
CLASS INFORMATION
SEMESTER      
Summer Days Camp 2012
 
 
Age Group
  2.5 – 3 Year Olds  3 Half Days (any 3 days – choose from list below)
  3 – 6 Year Olds  3 Half Days (any 3 days – choose from list below)
  2.5 – 3 Year Olds  5 Half Days
  3 – 6 Year Olds  5 Half Days
  3 – 6 Year Olds  3 Full Days (any 3 days, except Friday – choose from list below)
  3 – 6 Year Olds  4 Full Days and 1 Half Day on Friday
 
    Weeks Selected Days Selected (3-day program only)
 
  June 4-8 M T W Th F
  June 11-15   M T W Th F
  June 18-22 M T W Th F
  June 25-29 M T W Th F
  July 2-6 * M T W Th F
  July 9-13 M T W Th F
  July 16-20   M T W Th F
  July 23-27 M T W Th F
  July 30-August 3   M T W Th F
  August 6-10 M T W Th F
  August 13-17    M T W Th F
  *Summer Days Camp will be closed Wednesday, July 4 in observance of Independence Day

A NONREFUNDABLE deposit of $475.00 must accompany your application. The deposit will be credited toward the total camp fee and may not be applied to other programs. Full payment must be made by May 2nd.

One of our MAGIC team members will contact you shortly to confirm availability.

   
PAYMENT INFORMATION
       
Name on card Billing Zip Code
   
Card # Security #
   
Exp.Date (Month/Year):
   
I understand and accept all enrollment conditions contained in this release and medical waiver.*
Parent or Guardian Name* Date*
*required
Please email me event information and schedule updates.
       
 
Submitting this registration for classes acknowledges acceptance of all enrollment conditions, payment, refund and insurance policies at 74th St. MAGIC.
© Copyright 2009 - 74th Street MAGIC
510 East 74th Street, New York, NY 10021 • tel 212.737.2989 • fax 212.737.2993 • email magicinfo@74magic.com