Register Summer 17.pdf
THE SALVATION ARMY COMMUNITY CENTER 1216 E. 25th Court, Des Moines, Iowa 50317 Phone (515) 266-3156, Fax (515) 266-7347 www.salvationarmy-desmoines.org S U M M E R D A Y C A M P 2 0 1 7 REGISTRATION FORM Parent(s) and/or Legal Guardian(s) ______________________________ Mother
______________________________ Father
Address ________________________________________________________________________________________ Street City Zip Mother:
Home Phone _________________ Work Phone _________________ Cell Phone _________________ E-Mail Address _________________________________________________________________________
Father:
Home Phone _________________ Work Phone _________________ Cell Phone _________________ E-Mail Address _________________________________________________________________________
Name of Child ______________________________________ Male/Female Birthdate ___/___/___
Age ______
Name of Child ______________________________________ Male/Female Birthdate ___/___/___
Age ______
Name of Child ______________________________________ Male/Female Birthdate ___/___/___
Age ______
Please √ check the weeks and circle the days that your child/children will be attending: □
Week 1
June 12 –
June 16
# of children ______
Mon Tue Wed Thu Fri
□
Week 2
June 19 –
June 23
# of children ______
Mon Tue Wed Thu Fri
□
Week 3
June 26 –
June 30
# of children ______
Mon Tue Wed Thu Fri
□
Week 4
July 3
July 7
# of children ______
Mon
□
Week 5
July 10 –
July 14
# of children ______
Mon Tue Wed Thu Fri
□
Week 6
July 17 –
July 21
# of children ______
Mon Tue Wed Thu Fri
□
Week 7
July 24 –
July 28
# of children ______
Mon Tue Wed Thu Fri
□
Week 8
July 31 –
Aug. 4
# of children ______
Mon Tue Wed Thu Fri
□
Week 9
Aug. 7
Aug. 11
# of children ______
Mon Tue Wed Thu Fri
–
–
Wed Thu Fri
Daily care needed from _____ a.m. until _____ p.m. Early Drop Off/Late Pick Up Fees
Pre-arranged. Early (start at 7:15) $25/week, Late (until 5:15) $25/week Both Early and Late $35 a week per family
Late Pick Up Fees
Not Pre-arranged. $5 for each 15 minutes.
Please Note: You will be expected to pay for the days and weeks that you register for, unless you notify us in writing with two weeks’ notice. All fees are due in advance. The first week’s fees are due on the sign-up day and fees during the summer are due by Friday for the following week. Payments and fees are non-refundable. We accept cash, credit card, or debit card. NO CHECKS.
______________________________ Father
Address ________________________________________________________________________________________ Street City Zip Mother:
Home Phone _________________ Work Phone _________________ Cell Phone _________________ E-Mail Address _________________________________________________________________________
Father:
Home Phone _________________ Work Phone _________________ Cell Phone _________________ E-Mail Address _________________________________________________________________________
Name of Child ______________________________________ Male/Female Birthdate ___/___/___
Age ______
Name of Child ______________________________________ Male/Female Birthdate ___/___/___
Age ______
Name of Child ______________________________________ Male/Female Birthdate ___/___/___
Age ______
Please √ check the weeks and circle the days that your child/children will be attending: □
Week 1
June 12 –
June 16
# of children ______
Mon Tue Wed Thu Fri
□
Week 2
June 19 –
June 23
# of children ______
Mon Tue Wed Thu Fri
□
Week 3
June 26 –
June 30
# of children ______
Mon Tue Wed Thu Fri
□
Week 4
July 3
July 7
# of children ______
Mon
□
Week 5
July 10 –
July 14
# of children ______
Mon Tue Wed Thu Fri
□
Week 6
July 17 –
July 21
# of children ______
Mon Tue Wed Thu Fri
□
Week 7
July 24 –
July 28
# of children ______
Mon Tue Wed Thu Fri
□
Week 8
July 31 –
Aug. 4
# of children ______
Mon Tue Wed Thu Fri
□
Week 9
Aug. 7
Aug. 11
# of children ______
Mon Tue Wed Thu Fri
–
–
Wed Thu Fri
Daily care needed from _____ a.m. until _____ p.m. Early Drop Off/Late Pick Up Fees
Pre-arranged. Early (start at 7:15) $25/week, Late (until 5:15) $25/week Both Early and Late $35 a week per family
Late Pick Up Fees
Not Pre-arranged. $5 for each 15 minutes.
Please Note: You will be expected to pay for the days and weeks that you register for, unless you notify us in writing with two weeks’ notice. All fees are due in advance. The first week’s fees are due on the sign-up day and fees during the summer are due by Friday for the following week. Payments and fees are non-refundable. We accept cash, credit card, or debit card. NO CHECKS.
