Camp Melrose Registration Form
Camp Melrose Registration Form
Child’s Full Name _____________________________________________
Date of Birth __________________ Male ____Female____
Current School ________________________Grade(Sept. 2011) _______
Parents’ Names _______________________________________________
Address _____________________________________________________
City / State / Zip_______________________________________________
Home telephone ______________________________________________
Home e-mail__________________________________________________
Mother Cell ____________________ Father Cell ____________________
Mother Work ___________________ Father Work ___________________
Please check your preferences:
Week 1: June 13 – June 17 [ ] Morning Program [ ] 3 Full Days [ ] 5 Full Days Specialty Gr. 1-3 [AM]_________________ [PM]__________________ Specialty Gr. 4-6 [AM]_________________ [PM]__________________
Week 2: June 20 – June 24 [ ] Morning Program [ ] 3 Full Days [ ] 5 Full Days Specialty Gr. 1-3 [AM]_________________ [PM]__________________ Specialty Gr. 4-6 [AM]_________________ [PM]__________________
Week 3: June 27 – July 1 [ ] Morning Program [ ] 3 Full Days [ ] 5 Full Days
Week 4: July 5 – July 8 [ ] Morning Program [ ] 3 Full Days [ ] 5 Full Days
Please make checks payable to: The Melrose Summer Camp
(A deposit of one week’s tuition, per camper, is due upon registration.)
Mail forms and payment to:
Ellen Przymylski
Camp Melrose
120 Federal Hill Road
Brewster, N.Y. 10509
