lfny summer camp registration - Lycée Français de New York

lfny.org

lfny summer camp registration - Lycée Français de New York

LFNY SUMMER CAMP REGISTRATION

CHILD’S NAME ________________________________________

ADDRESS _____________________________________________

PHONE # ______________________________________________

DATE OF BIRTH _______________________________________

GRADE ENTERING AS OF SEPTEMBER ’11 _______________

MALE FEMALE (PLEASE CIRCLE)

ALLERGIES ___________________________________________

______________________________________________________

______________________________________________________

(PLEASE PROVIDE US WITH A MEDICAL CERTIFICATE REGARDING ANY

ALLERGIES)

ADDITIONAL INFORMATION YOU WISH TO PROVIDE US WITH:

_______________________________________________________

_______________________________________________________

_______________________________________________________

CONTACT INFORMATION

PARENT/GAURDIAN

__________________________

ADDRESS ________________

__________________________

PHONE # _________________

CELL # ___________________

EMAIL ___________________

PARENT/GUARDIAN

___________________________

ADDRESS _________________

___________________________

PHONE # __________________

CELL # ____________________

EMAIL ____________________


EMERGENCY CONTACT:

NAME __________________________________________

PHONE # ________________________________________

CELL # _________________________________________

ADDRESS _______________________________________

RELATION TO CHILD _____________________________

CAMP INFORMATION

CAMP HOURS : 9:00 AM TO 3:00 PM

SESSION DATES:

WEEK 1 : JUNE 22 – JUNE 28

WEEK 2 : JUNE 29– JULY 5 (WE WILL BE CLOSED ON JULY 4 th )

WEEK 3 : JULY 6 – JULY 12

WEEK 4 : JULY 13 – JULY 19 (WE WILL BE CLOSED ON JULY 14 TH )

WEEK 5 : JULY 20 – JULY 26

PRICING:

5 WEEKS - $3,100

4 WEEKS - $2,600

3 WEEKS - $2,100

2 WEEKS - $1,600

1 WEEK - $1,100

PLEASE CIRCLE BELOW THE WEEKS YOU WOULD LIKE YOUR CHILD

TO ATTEND:

5 WEEKS

4 WEEKS (please list the weeks)___________________________________

3 WEEKS (please list the weeks)___________________________________

2 WEEKS (please list the weeks)___________________________________

1 WEEK (please list the week) _____________________________________

**please mail $300 non-refundable deposit to :

Lycee Francais de New York

ATTN: Amy Zuflacht

505 East 75 th Street

New York, NY 10021

**please make checks payable to : LFNY

More magazines by this user
Similar magazines