Virtual Activities Registration Form 2020

Camper’s Last Name

First Name

Gander MaleFemale

Age

Grade As Of September 2020

Address

City

Zip Code

Home Phone

Camper’s Birth Date

Email address

Father’s Name

Father’s Business Phone

Father’s Cell Phone

Mother’s Name

Mother’s Business Phone

Mother’s Cell Phone

The fee for this 8 week program is $1,200. Parents who have already given a deposit or paid towards their 2020 tuitioncan use that money to pay for part of this program. Tuition includes 4 activities a day and each activity thirty minutes in length. There are no refunds for this program. Campers must have internet access to participate in this program. Payment is made by printing this form and mailing a check to P.O. Box 725 Plainview, NY 11803