Gibraltar C.I.A. Summer Camp

Registration Form

One per child

Last Name:_______________________First Name:_________________________Birth date:___________

Street Address:_______________________________City/Zip_______________________________

Mother’s Name_________________________________Home Phone:_________________________

                                                                                                     Cell Phone:__________________________

Father’s Name__________________________________Home Phone:_________________________

                                                                                                     Cell Phone:___________________________

Circle all weeks and days you wish your child to attend:

6/16-6/20  M  T  W  TH  F            6/23-6/27  M  T  W  TH  F        6/30-7/3(Closed 7/4) M  T  W  TH 

7/7-7/11  M  T  W  TH  F              7/14-7/18 M  T  W  TH  F         7/21-7/25  M  T  W  TH  F

7/28-8/1  M  T  W  TH  F              8/4-8/8  M  T  W  TH  F             8/11-8/15  M  T  W  TH  F

8/18-8/22  M  T  W  TH  F

Time of day your child will be attending:________________________________________

Age of your child;   3 – 5 years old                  6 - 9 years old             10 – 12 years old

Will you be purchasing pizza lunch?  Yes or No

Please supply us with the following information about your child.

Shoe size________________adult/child

Shirt size________________adult/child

Signature of adult who has filled out this form_____________________________________________

A $50.00 deposit is due at the time of registration.  $25.00 is a non-refundable enrollment fee per child.  The remaining $25.00 will be applied to the last week of service.

Make checks payable to Gibraltar School District.

Registration forms along with the deposit can be mailed to:

Gibraltar Early Childhood Education Center

21762 Harding  Rockwood MI 48173

Attn: Terri Calmus