PVSD Summer Camp 2019
Student #1 First Name
Your answer
Student #1 Last Name
Your answer
Student #1 Gender
Student #1 Birthday
MM
/
DD
/
YYYY
Student #1 Grade
2018-2019 School Year
Student #1 Current School
Student #1: Are there any special conditions which we need to be aware of when providing care for your child?
If Yes, Click Other and please explain
Student #1: Does your child take medication daily or on an as needed basis (i.e. inhaler for asthma, Benadryl for allergies, etc)?
If Yes, Click Other and please explain
Student #1: The sessions are now full. Please select the sessions below where you would like Student #1 to be placed on the waiting list.
$50 per child per session deposit is required to be placed on the waiting list. Payments will be made through Payschool
Student #1 would like to be placed on the waiting list
Session 1: June 17 - 28 -- $400
Session 2: July 1 - 12 -- $360
Session 3: July 15 - 26 -- $400
Session 4: July 29 - Aug 9 -- $400
#1 Will you be enrolling another student in the PVSD Summer Camp? *
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