Summer 2018 Camp Registration

Is your child enrolled in Acera's school year day program?

YesNo

Child information

Child First name	Child Last Name
Date of Birth	Gender
Health/Safety Notes allergies? epi-pen?

Class Information

Choose your week

Choose your class

Class Tuition Deposit

Class Cost

What would you prefer to pay now?

Tuition Deposit total only (Final balance due May 1, 2018)Full cost with early bird discount

Total Tuition Deposit charges

Total for all selected classes prior to discount

Total for all selected classes

(includes 25% Acera family discount for registration & payment prior to 2/28)

Total for all selected classes

(includes 20% discount for registration & payment prior to 2/28)

Parent/Guardian 1 Information

I have another Parent/Guardian to enter

YesNo

Parent/Guardian 2 Information

Payment Information

Total Charges

Name on Card

Card Number

Code

Billing Email