Summer 2008 at Hill

Registration Form - A separate application, completed and signed on BOTH sides, is required for each applicant

Child's Name: __________________________________________ Boy: _____ Girl:_____

Date of Birth: _______________ Grade entering in the fall: ___________

Parent/Guardian Name(s) _______________________________________

Mailing Address: ____________________________________________________________________

Home Phone Number: (____)______________

Daytime Phone (father): (____)______________ Daytime Phone (mother): (____)______________

Cell Phone(s): (____)______________ (____)______________

Child's Doctor and Phone Number: ____________________________ (____)______________

Emergency Contact (Name and Number): _________________________ (____)______________

T-Shirt size (circle one): Youth: M L Adult: S M L XL

Permission to Administer Emergency Treatment: In the case of a medical emergency, and in the event that the parent/guardian cannot be reached, I hereby give my permission for emergency treatment to be administered to ____________________. I agree to assume liability for any expenses incurred (transportation, hospitalization, x-rays, etc.)

Please describe any Allergies, Medical Conditions, Medications, Special Needs, and Restrictions for your child:

_____________________________________________________________________________________________

I do hereby verify that my child ______________________, to the best of my knowledge, is free from any contagious disease, is fully immunized, and is able to participate fully in the summer program(s) with the exceptions listed above.

Please make sure that you have completed and signed the release form on the reverse side as well.

Financial Information: The non-refundable reservation fee (listed below) for each camp is due with this registration. Balance is due in full on the FIRST day of camp. If paid by June 15th, there is a 5% discount.

Signature: _______________________________ Date: _____________

T	Date	Camp	Fee (total)	Res. Fee (25%)
	July 7 - July 11	Gymnastics	$225	$55
	July 14 - July 18	Cooking Camp I	$150	$35
	July 14 - July 18	Lacrosse I Boys - 2nd&3rd graders (9:00-noon)	$125	$30
	July 14 - July 18	Lacrosse I Boys - 4th-12th graders (9:00-3:00)	$200	$50
	July 14 - July 25	Doris Weeks Watercolor Camp	$200	$50
	July 14 - July 18	NEW: Swan Lake Dance Camp	$125	$30
	July 21 - July 25	Basketball Camp	$200	$50
	July 21 - July 25	Kiddie Camp I	$125	$30
	July 21 - July 25	Cooking Camp II	$150	$35
	July 21 - July 25	Dr. Dan’s Great Puppet Adventure	$150	$35
	July 28 - August 1	Kiddie Camp II	$125	$30
	July 28 - August 1	Soccer	$130	$33
	July 28 - August 1	Ultimate Theater - 3rd-5th graders (9:00-noon)	$125	$30
	July 28 - August 1	Ultimate Theater - 6th-8th graders (1:00-4:00)	$125	$30
	July 28 - August 1	Adventure Camp	$250	$60
	August 4 – August 8	NEW: Jungle Book Musical Theater Camp	$200	$50
	August 4 - August 8	Lacrosse II (Co-ed) - 2nd&3rd graders (9:00-noon)	$125	$30
	August 4 - August 8	Lacrosse II (Co-ed)- 4th-12th graders (9:00-3:00)	$200	$50
	August 4 - August 8	Mr. Dan’s Fun Camp	$125	$30
	August 4 - August 8	Lego Construction	$130	$33
	August 11 - August 15	Field Hockey Camp	$170	$45
	August 11 - August 15	Construction Capers	$200	$50