2009 MMS SUMMER CAMP REGISTRATION
Student's Name
1. ________________________________ Date of Birth______________

2. ________________________________ Date of Birth______________

3. ________________________________ Date of Birth______________

Parent's Name: __________________________________________________
Home Phone#: ___________________________________________________
Address:
Street ________________________________________________________
City _________________________________ZIP__________

Mother's Work#: _____________________ Cell#:________________________
Place of Employment ____________________

Father's Work#: _____________________ Cell#:________________________
Place of Employment ____________________

Please list emergency contacts and persons who may check your child out of camp.
Only persons named below will be allowed to check out your child. Use reverse side
to list additional persons.
Name/Relationship_______________________________Contact # _____________

Name/Relationship_______________________________Contact # _____________

Does your child have any medical condition, special needs (physical or emotional)
or the need for one-on-one supervision? Examples are allergies or conditions that
limit or disallow participation in physical activities. If so, please name the condition
and be specific regarding the limitation. Failure to full disclosure could result in
cancellation of camper's participation/attendance. Use reverse side to elaborate.
My child is a _______swimmer, ________non-swimmer

Field Trip Permission Form
My child/children have permission to attend all field trips planned by MMS Summer
Camp Program. Transportation will be provided by school bus.
__________________________________________________________________
Parent Signature

Please enroll my child/children in the following weeks
I have attached a check or money order for $50.00 per week/per child to reserve a place.
_____Week 1: June 1-5
_____Week 2: June 8-12
_____Week 3: June 15-19
_____Week 4: June 22-26
__

Email address: __________________________________________________________

-A confirmation email will be sent to you indicating registration is complete.

Each camper will receive one complimentary t-shirt with enrollment. Campers are
encouraged to wear their camp t-shirts every day that they attend camp, especially
when we leave the school site. If you would like to purchase additional t-shirts,
please indicate the number and size below.

Each shirt costs $10.00. Please include pre-payment for the shirts with your registration deposit.

Number of shirts _______________ Total $ ___________

Select size:
_____ Youth S _____ Adult S
_____ Youth M _____ Adult M
_____ Youth L _____ Adult L