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:

6/15-6/19  M  T  W  TH  F            6/22-6/26  M  T  W  TH  F        6/29-7/3M  T  W  TH  F

7/6-7/10  M  T  W  TH  F              7/13-7/17 M  T  W  TH  F         7/20-7/24  M  T  W  TH  F

7/27-7/31  M  T  W  TH  F              8/3-8/7  M  T  W  TH  F             8/10-8/14  M  T  W  TH  F

8/17-8/221  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.  $35.00 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