Summer 2019 Camp Registration

What would you prefer to pay now?

Full Cost with any discounts applied or for waitlisted classes only

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

If you select a full class, you will not be charged tuition until your child has been removed from the waitlist and enrolled in the class. A summer camp staff member will be in touch with you about the space availability if spots become available.

Class Cost

Are you available to be a carpool driver for this session (either to or from Acera)?

If so, summer staff will share your email address with other families who live near you and are seeking transportation options.

Are you interested in a carpool for your child, as passenger, for this session (either to or from Acera)?

If yes, your email will be shared with car pool driver volunteers

Grand Total Before Discounts

A final bill summary and payment link will be emailed to you immediately after submission of this form. If your selections qualify for an AM/PM discount, it will be reflected within this summary.

Parent/Guardian 1 Information

Parent/Guardian First Name	Parent/Guardian Last Name	Relationship
Street Address	City	States
Postal Code	Mobile Phone	Work Phone
Home Phone	Occupation	Employer
Email

I have another Parent/Guardian to enter

YesNo

Parent/Guardian 2 Information

Parent/Guardian First Name	Parent/Guardian Last Name	Relationship
Street Address	City	States
Postal Code	Mobile Phone	Work Phone
Home Phone	Occupation	Employer
Email

Submit and then check your email for a bill summary

Shortly after you press submit, check your email for a bill summary and link to complete payment. If your selections include AM/PM classes for the same week, a 10% discount will be applied to both classes. Your child is not enrolled in the classes until you successfully complete payment.

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