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 2013

 
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 3-7
M T W Th F
June 10-14  
M T W Th F
June 17-21
M T W Th F
June 24-28  
M T W Th F
July 1-3  
M T W Th F
July 8-12  
M T W Th F
July 15-19  
M T W Th F
July 22-26  
M T W Th F
July 29-August 2  
M T W Th F
August 5-9  
M T W Th F
August 12-16  
M T W Th F

*Summer Days Camp will be closed Thursday, July 4 and Friday, July 5 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 Methods (Choose One)

Credit Card

   
Name on card Billing Zip Code
   
Card # Security #
   
Exp.Date (Month/Year):

Coupon/Voucher

Coupon/Voucher Description

Issued by (MAGIC or other, please specify)

Coupon/Voucher Number (if applicable)

Additional Information

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.