Poinciana Villages Summer Camp Registration Form

REGISTRATION FOR WEEK 6: July 18 - July 22

NOW CLOSED.

2016 APV Summer Camp Registration Form

Please note that all fields followed by an asterisk must be filled in.

Parent/Guardian First Name*

Parent/Guardian Last Name*

E-Mail Address*

Street Address*

City*

State/Prov*

Zip/Postal Code*

Home Phone*

Student's Name*

Age *

School

Please list ADA Accommodations needed

Please check the week(s) you wish to participate:*

	July 25th-July 29th ($65/week)
	August 1st-August 5th ($65/week)

Single Day Camper-Please specify Date

Extended Day Hours 6:30am-7:00pm (Additional $25/week)

	YES, I wish to sign my child up for the extended camp hours
	NO, I do not wish to sign my child up for the extended camp hours

Camp Rotations - Please choose 2:*

	Acting Lessons
	Music/Dance Lessons
	Art Instruction
	Cooking/Nutrition

Approved Child Pick Up (Please list first and last names)

Emergency Contact (Please list names, phone numbers, and relation)

Transportation To and From Camp*

Total Fees Due

Payment in full by June 10th - Payment Type

	Check
	Cash
	Online
	CC

Statement of Understanding*

By checking this box I accept and understand that there are 8 weeks of OPMI Summer Camp ($65/per week) beginning June 13th-August 5th. Summer Day camps are from 7:30am-6:00pm, Extended drop off and pick up are from 6:30am-7:30am and 6:00pm-7:00pm which has an additional cost of $25. For a single summer day camp registration (drop off/pick up) the daily fee is $32.50. There will be a onetime registration fee of $20 upon the first week of summer camp sign up. Any portion of the camp that my child cannot attend shall be forfeited without refund or credit. I also understand that I am responsible for picking up my child from camp on time. If I am more than 10 minutes late, I accept and understand that fees will be applied. I also understand that any belongings I send my child to camp with are the responsibility of my child and OPMI nor the Association of Poinciana Villages is responsible for lost, damaged, or stolen items.

Special Needs/Concerns:

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2016 APV Summer Camp Registration Form

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