UDCNS Summer Camp Registration 2023

Please fill out this form for each child that you are registering and click submit.

Full Name of Student

Student Age

Parent 1 Name and cell Number

Parent 1 Email

This address will receive a confirmation email

Parent 2 Name and cell number

Does your child receive services from MCIU? Have any food allergies?

Camp Selection

Week 1 June 19th to June 23rd

Please select all that apply.

3 days Tues/Wed/Thursday Weekly Rate $105 3 days Tues/wed/thursday with Lunch Bunch $135 5 days Mon-Friday Weekly Rate $175 5 days with Lunch Bunch weekly rate $225

Week 2 FULL

Please select all that apply.

Week 3 July 10th to July 14th

Please select all that apply.

3 days Tues/Wed/Thurs Weekly Rate $105 3 days with lunch bunch weekly rate $135 5 days Mon-Fri Weekly rate $175 5 days Mon-Fri. with lunch bunch weekly rate $225

Week 4 July 17th to July 21st

Please select all that apply.

3 days Tues/Wed/Thurs Weekly Rate $105 3 day with lunch bunch weekly rate $135 5 days Mon-Friday Weekly Rate $175 5 day with lunch weekly rate $225

Week 5 July 24th to July 28th FULL

Please select all that apply.

3 days Tues/Wed/Thurs Weekly Rate $105WAITLISTED 3 days with lunch weekly rate $135WAITLISTED 5 days Mon-Friday Weekly Rate $175 WAITLISTED 5 days with lunch weekly rate $225 WAITLISTED

Week 6 July 31st to August 4th

Please select all that apply.

3 days Tues/Wed/Thurs Weekly Rate $105 3 days with lunch bunch weekly rate $135 5 days Mon-Friday Weekly Rate $175 5 days with lunch bunch weekly rate $225

Total weeks and Total amount due

Payment Options

Please Sign and Date

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form for each child that you are registering and click submit.

UDCNS Summer Camp Registration 2023

Description

Please Fix the Following