The Melrose School

Camp Melrose Registration Form

Camp Melrose Registration Form

Child’s Full Name _____________________________________________

Date of Birth __________________ Male _______ Female_______

Current School ______________________ Grade (Sept. 2009) ________

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 14 – June 18 [ ] Morning Program [ ] 3 Full Days [ ] 5 Full Days Specialty Gr. 1-3 [AM]_________________ [PM]__________________ Specialty Gr. 4-6 [AM]_________________ [PM]__________________

Week 2: June 21 – June 25 [ ] Morning Program [ ] 3 Full Days [ ] 5 Full Days Specialty Gr. 1-3 [AM]_________________ [PM]__________________ Specialty Gr. 4-6 [AM]_________________ [PM]__________________

Week 3: June 28 – July 2 [ ] Morning Program [ ] 3 Full Days [ ] 5 Full Days

Week 4: July 5 – July 9 [ ] 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