to download the 2013 Camp Brochure with registration form!

Camp at the Suffolk County Farm and Education Center Registration Form
Registration also available online at: www.ccesuffolk.org under the CAMPS section.
Use a separate registration form for each child.
Child’s First Name_________________________________ Last Name_________________________________ Age_______ Grade Entering_____________
Parent/Guardian’s Name_______________________________________________________
T-Shirt Size (check one) CHILD ❑ S ❑ M ❑ L or ADULT ❑ S ❑ M ❑ L ❑ XL
Address_______________________________________________________________________________________________________________________
City_______________________________________________________________________ State_____________________ Zip Code__________________
Phone (H)______________________ (W)______________________ (C)______________________ Email________________________________________
Please check the applicable fees for the session you are enrolling. Write the total amount in the last column. Totals
FARm ANImAL CARe 101 - 1st Time Participants • Grades 10-12 July 1, 2, 3, 5 8:30 am-3:30 pm ❑ $300
FARm ANImAL CARe 201 - For Repeat Participants Grades 10-12 July 1, 2, 3, 5 8:30 am-3:30 pm ❑ $300
Week 1
July 8-12
Week 2
July 15-19
Week 3
July 22-26
Week 4
Jul 29-Aug 2
Week 5
August 5-9
Week 6
Aug 12-16
Explorers
Grade K
Half Full
Pioneers
Grades 1-2
Trailblazers
Grades 3-4
Navigators
Grades 5-6
STEM
Grades 7-9
Dog Days
Grades 5-8
Before Care
7-8:30 am
After Care
3:30-5 pm
Before &
After Care
ext. After
Care 5-6 pm
❑ $150 ❑ $225 ❑ $225 ❑ $225 ❑ $225 ❑ $250 ~ ❑ $45 ❑ $45 ❑ $70 ❑ $15
❑ $150 ❑ $225 ❑ $225 ❑ $225 ❑ $225 ❑ $250 ~ ❑ $45 ❑ $45 ❑ $70 ❑ $15
❑ $150 ❑ $225 ❑ $225 ❑ $225 ❑ $225 ❑ $250 ~ ❑ $45 ❑ $45 ❑ $70 ❑ $15
❑ $150 ❑ $225 ❑ $225 ❑ $225 ❑ $225 ❑ $250 ❑ $250 ❑ $45 ❑ $45 ❑ $70 ❑ $15
❑ $150 ❑ $225 ❑ $225 ❑ $225 ❑ $225 ❑ $250 ~ ❑ $45 ❑ $45 ❑ $70 ❑ $15
❑ $150 ❑ $225 ❑ $225 ❑ $225 ❑ $225 ❑ $250 ~ ❑ $45 ❑ $45 ❑ $70 ❑ $15
eARLy BIRD SPeCIAL*: Take $10 off each week when you register by mail before April 26 th . ❑ -$
ReFeRRAL DISCOuNT*: Refer a new registrant and get $10 off your total. New referred registrants must mention your name in the “How did you hear
about camp” section of their Registration form.
4-H CLuB DISCOuNT*: 4 H member deduct 10% from each week. Must include club name: ❑ -$
SIBLING DISCOuNT*: get each additional sibling after the first child at 5% off each week. ❑ -$
Billing Information:
Check #_____________________(made payable to Cornell Cooperative Extension)
❑ -$
Grand Total:
Charge: ❑ Visa ❑ MasterCard Card #____________________________________________Exp. Date___________Signature_________________________
How Did You Hear About Camp?
❑ Library ❑ School ❑ CCE Website ❑ Internet ❑ Newspaper (which one?)___________________________ ❑ Other______________________________
❑ Radio ❑ Referred by:_______________________________________________________________(to be used for referral discount)
Please mail completed registration form to: Suffolk County Farm and Education Center, 350 Yaphank Avenue, Yaphank, NY 11980