KidZone Summer Camp 2010

Online Registration

Note: Full Day Camp 8:30 to 2:30pm. Extended hours are available to 5:30pm upon request and availability the extra cost is $50 per week.

Mother's Name *
Father's Name
Student's Name
Student's Age
Home Address
City
Zip
Phone *
Emergency Phone *
e-mail *
2nd e-mail
Name of Referral
Allergies *	Yes No
Program *	Fun Camp Quickstart Camp
Choose Product	Week of July 12 (175.00 USD) Week of July 19 (175.00 USD) Week of July 26 (175.00 USD) Week of August 2 (175.00 USD) Week of August 16 (175.00 USD) Week of August 9 (175.00 USD) Total:

Mother's Name *
Father's Name
Student's Name
Student's Age
Home Address
City
Zip
Phone *
Emergency Phone *
e-mail *
2nd e-mail
Name of Referral
Allergies *
Program *
Choose Product

If you prefer sending payment by mail. Fill the above form, Click on "Register & PayOnline" and send us payment directly. Remember that you are not register until payment is received.