	Registration Form 2011 Please complete form for each camper, print out & mail with payment to:
	Park Day Summer Arts Camp 4344 Broadway Oakland, CA. 94611 510-719-8652

	Child's Name:	Age: Boy Girl

	School:

	Parents:

	Address:

	City/Zip:

	Phone:

	Work Phone:
	E-mail:


	One week: $350 / Two consecutive weeks: $660 3/4 Days (8:30 am - 3:45 pm)@ $320 per week Extended care $30 per week (8 to 8:30 am or 5:30 to 6 pm)

	My check for is enclosed. PayPal sent Payment in Full per child ($100 non refundable - included in full payment) Please make checks payable to: Park Day Summer Arts Camp

	Extended care: am pm 3/4 Days (8:30 am to 3:45 pm) CIT Program Jr. CIT Program

	*Please enroll my child(ren) for the following weeks:*

	June 20 - 24 FULL	July 11 - 15 FULL	Aug. 1 - 5 FULL
	June 27-July 1 FULL	July 18 - 22 FULL	Aug. 8 - 12 FULL
	*July 5 - 8 FULL	July 25 - 29 FULL	Aug. 15-19 FULL
			Aug. 22 - 26 FULL
	closed July 4th...deduct $40 for this week. *New Added Week

	Special Information About Your Child:

	Are there any special concerns or needs teachers should be aware of? Please be specific; include medical, physical, social, behavioral, emotional, learning, hearing, visual, or other issues. Special groupings with age related friends?