Tiny Treasures 2011 Summer Camp Application
   
Child's Name:________________________  
Date of Birth:_________________________ Age in June:___________________________
Street Address:_________________________________________________________________
Town:_______________________________ Zip:__________________________________
Phone (home):_________________________  
   
Mother's Name:________________________ Phone (work):__________________________
Address(if different)_____________________ Phone (cell):___________________________
Father's Name:_________________________ Phone (work):__________________________
Address(if different)_____________________ Phone (cell):___________________________
Emergency contacts (name and number) (1)______________________________
   (2)___________________________________
Medical information  
In the event of a medical emergency, I authorize Tiny Treasures to seek emergency care for my child as deemed necessary.
Signature_____________________________ Date:_________________________________
 Doctor : ______________________________        (number) ______________________________
DOES YOUR CHILD HAVE ANY ALLERGIES THAT WE NEED TO KNOW ABOUT?    ___________________________________________________________
 
Yes, I give Tiny Treasures permission to take pictures of my child, which may be used on our web page.
Signature_____________________________ Date:_________________________________
   
Please Sign
I wish to register my child for Tiny Treasures Summer Camp.
   
Signature_______________________________ Date:___________________________________
   
Registration Fee $__________  1st week payment $_________ Total enclosed $___________
   
   
Name:________________________ Age:   ________________________
 Please circle the session and days you will need
  MON          TUES          WED          THURS          FRI          Full Day        Half Day
 
Session 1: June 27th - July 1st  
Session 2: July 5th - July 8th                (closed Monday the 4th for the holiday)
Session 3: July 11th - 15th                
Session 4: July 18th - 22nd
Session 5: July 25th - 29th                         
Session 6: August 1st - 5th
Session 7: August8th - 12th                       
Session 8: August 15th - 19th              
Session 9: August 22nd - 26th              
Session10: August 29th- 31st (closed Thursday and Friday to prepare for school year)
Weekly Rates: (Two week minimum)
Before Care/After Care $6.50 per child per hour _____________________________

Half Day 9:00 am - 12:00 pm

2 days $  65.00 a week
3 days $  85.00 a week
4 days $  95.00 a week
5 days $115.00 a week

Full Day 9:00am-3:30pm

2 days $  90.00 a week
3 days $115.00 a week
4 days $145.00 a week
5 days $175.00 a week
Monthly Rates:

Half Day 9:00 am - 12:00 pm

2 days $ 215.00 a month
3 days $ 282.00 a month
4 days $ 337.00 a month
5 days $ 378.00 a month

Full Day 9:00am-3:30pm

2 days $  337.00 a month
3 days $ 455.00 a month
4 days $ 567.00 a month
5 days $ 682.00 a month

Registration Fee ( non-refundable) $25.00

Session 1-4 :     Payment due June 1st
Session 5-8: Payment due July 1st
Session 9-10 : Payment due August 1st

Any tution paid after due date will require a $15.00 dollar late fee.