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Form
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Child/Children's Name(s)
_____________________________________________
_____________________________________________
Ages(s)_______________________________________
M/F _____ M/F _____ M/F _____
School _______________________________________
Grades_______________________________________
Parent's
Name________________________________________
Phone________________________________________
Address_______________________________________
City__________________________________________
State______Zip_________________________________
I UNDERSTAND THAT THE DEPOSIT AND BALANCE PAID ARE BOTH NON REFUNDABLE
[ ] PLEASE SEND ME AN APPLICATION TO REGISTER MY CHILD/CHILDREN FOR THE 2010 SUMMER SESSION.
$35.00 deposit/processing fee must accompany this form. Upon receipt, we will send you registration and medical forms, and information.
Please make checks payable to "Mishkan Israel Day Camp" and mail to:
Mishkan Israel Day Camp
P.O. Box 11196
Greenwich, CT 06831