Senior Camp Registration Form
Summer @ Melrose 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 note: A minimum number of students will be required to offer any given course. Class size will be limited to 10 students.)
If full day, please check both AM and PM.
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
*Weeks 1 and 3 are prorated due to shortened week.
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:
Adele Dominicus
Melrose Summer Camp
120 Federal Hill Road
Brewster, N.Y. 10509
