Application for Summer Camp Enrollment
Summer camp runs from 9:30-12:30 during the weeks of June 1-4 & June 8-11 2020.

****** You must provide a $225 non-refundable tuition fee within 5 business days for this Registration form to be valid. More information at the bottom of this form ******
Email address *
Which class is your child in?
Child's First Name *
Your answer
Child's Last Name *
Your answer
Sex *
Birth Date *
MM
/
DD
/
YYYY
Name of Parent/Guardian #1 *
Your answer
Email of Parent/Guardian #1 *
Your answer
Name of Parent/Guardian #2
Your answer
Email of Parent/Guardian #2
Your answer
Who else will pickup your child?
Your answer
Cell Phone *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone *
Your answer
Does your child have any food allergies? *
Is there any present condition that the school should be aware of in the planning of your child's program (i.e. visual, hearing, allergies, medication, early intervention, speech and/or occupational therapy services, etc)? Please explain.
Your answer
Digital Signature of Parent/Guardian
Your answer
PLEASE READ:
By digitally signing this document, the signee has agreed to provide a non-refundable $225 tuition fee to save their child's spot. Please provide a check in the payment box or send to our PO BOX: Tri-Village Nursery School, P.O. Box 103, Delmar, NY 12054. In your check notes, please write the name of the child and Summer Camp. The check must be provided within 5 business days to hold your spot. Checks sent to our PO BOX must be stamped within the 5 business day period. If there is a delay with your check, your child will be placed on the bottom of the class list until receipt. If the class fill capacity, your child will be placed on the waitlist until receipt.
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