Junior Camp Registration Form
Summer @ Melrose Junior Camp Registration Form
Child’s Full Name ………………………………………………..
Date of Birth…………………………… Sex………. Age………….Grade entering in September 2008……………. Current School…………………………….
Parents’ names……………………………………………………………………………………………….
Address………………………………………………………………………………………………………
Home Phone (…...)…………………………… Cell Phone (……)……………………………………….
Mother’s Business (…….)……………………………… Father’s Business (…….)………………………
How did you hear about us? …………………………………………………………………………………
Please check your preferences: (Weeks 1 and 3 are prorated due to shortened week.)
Week 1, June 18-20: _____ AM Program _____ PM Program
Week 2, June 23-27: _____ AM Program ____ PM Program
Week 3, June 30–July 3: _____ AM Program ____ PM Program
Week 4, July 7-11: _____ AM Program _____ PM Program
Week 5, July 14-18: _____ AM Program _____ PM Program
*Please make all checks payable to: Summer at Melrose.
(A deposit of one week’s fee, per camper, is due upon registration.)*
Mail forms and checks to:
Adele Dominicus, Summer Camp Director
Melrose School Summer Camp
120 Federal Hill Road
Brewster, N.Y. 10509
