ENCORE Summer Experience - Summer 2018
Cancellation/Refund Policy
Cancellation refund will be given less deposit fee within 14 days notice of the child’s start date. No refunds will be given less than 14 days prior to start of session or for missed sessions.
Email address *
Camper's Full Name *
Last Name, First Name
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Child's Current Age *
Your answer
School *
Your answer
Year Level Completed in June 2018 *
Parent/Guardian Name(s) *
Your answer
Home Address *
Your answer
Home Telephone
Your answer
Work Telephone
Your answer
Cell Phone *
Your answer
Best way to contact you? *
T-shirt Size *
Select which week(s) your child will attend *
Required
Place the following elective classes in your preferred order? [Robotics, Dance, Drama] *
Your answer
Has your child had any prior experience with coding? *
Will your child take part in our Extended Encore Experience (E3)? Additional $25/week or $10/day per child (latest pick up 5:30pm) *
Select the days your child will attend E3 *
Required
How will your child get home? *
Car riders: Who will pick up your child? Bus riders: Which bus route/number? Walkers: Where will they walk? *
Your answer
My child has permission to swim: (If yes, please describe your child’s swimming ability below) *
Does your child have any medications, allergies, special needs or learning challenges? If so please specify... *
Your answer
Child's Pediatrician & Contact Number *
Your answer
Emergency Contact - Relationship - Email/Phone Number *
Your answer
Choose your method of payment ($30 deposit due with registration, the balance is due 7 days prior to your child's start date) *
Required
Credit/Debit Card Number, Expiration Date, CVV, Postal Code
Your answer
How did you hear about ENCORE Summer Experience? *
Required
Additional Information
Your answer
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