Long Island City Summer Arts Camp Registration
Student Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Sibling #1
5% discount
Your answer
Date of Birth
MM
/
DD
/
YYYY
Parents Name
Your answer
Email
Your answer
Primary Phone
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Additional Phone
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Medical Alerts
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Food Allergies
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Weeks Attending
$400 per week
Required
Early Drop Off 8am -- Additional $75 per week
Please choose payment method
All credit card transactions, including Paypal, incur a 2.9% transaction fee. Checks have no additional fees.
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