Summer Camp Registrtion Form In Norbeck Montessori Summer Camp Registrtion Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Type of Student * New Student Returnee Child's Name *Age *Birth Date *GenderMaleFemaleAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNameRelationship to ChildMotherStep-MotherLegal GuardianHome PhoneCell Phone *Work PhonePrimary E-mail *NameRelationship to ChildFatherStep-FatherLegal GuardianHome PhoneCell Phone Work Phone Primary E-mail *Allergies *Program PlanSummer Camp Program *6/19 - 6/23 (Norbeck is closed on 6/19 in observance of Juneteenth. First day of camp is 6/20 deg)6/26 - 6/307/3 - 7/7 (Norbeck is closed on 7/4 in observance of July 4th)7/10 - 7/147/17 - 7/217/24 - 7/287/31 - 8/48/7 - 8/118/7 - 8/118/14 - 8/16 (Norbeck is closed for Professional Days on 8/17 & 8/18)8/21 - 8/25 Norbeck is closed for Teacher Work Week *I have included a $200 NON-REFUNDABLE Deposit and a $25Application FeeI understand additional childcare is available for children in Plans 2 and 3. The additional fee per hour for children in Plan 2 or Plan 3 is $11.00I have checked all the sessions I wish to reserve for my child. I realize I will be billed for each session I have reserved unless I submit written notice to Norbeck Montessori. This notice must be received two weeks in advance. NOTIFYING A STAFF MEMBER DOES NOT CONSTITUTE PROPER.NOTIFICATION. No allowances can be made for absences due to illness, disability or change in personal plans. MY CHILD WEARS DIAPERSYesNoMY CHILD IS IN UNDERWEAR ALL DAYYesNoSignature Clear Signature Signature is Required MY CHILD WEARS PULL UPSYesNoMY CHILD WILL TAKE A NAP AT CAMP AFTER LUNCH (TODDLER ROOM ONLY)YesNoDate / TimeDateTimeSubmit
