Child Registration Form

(Fields marked with * must be filled in)

PRINT OUT AND COMPLETE APPLICATION. SEND TO THE ADDRESS AT THE BOTTOM

OF THE FORM (save a copy for your records)

PARENT INFORMATION

Father’s First Name*________________________________________

Mother’s First Name*________________________________________

Father’s Last Name*________________________________________

Mother’s Last Name*________________________________________

Street Address* __________________________________________________________

City* _____________________________________________

State* _____________________________________________

Country* __________________________________________

Zip Code* _____________________

Home Phone* ______________________________________

Work Phone _______________________________________

Fax ___________________________

E-Mail* __________________________________________

Occupation of parents ________________________________________

Nationality* _______________________________________

Emergency Contact Name & Phone Number*

____________________________________________________________________

How did you hear about us?

____________________________________________________________________

Will a parent be attending the adult immersion classes on the same weeks as the child?*

______Yes _______ No

CHILD INFORMATION

Please provide the following information on you child/children who will be attending camp:

1. _____________________________________ _______________ _____

(Name: First & Last) (Date of Birth) (Age)

Sex (circle one): male female

Language Level* (circle one): beginning intermediate advanced

Special interests: _____________________________________________________

2. _____________________________________ _______________ _____

(Name: First & Last) (Date of Birth) (Age)

Sex (circle one): male female

Language Level* (circle one): beginning intermediate advanced

Special interests: _____________________________________________________

3. _____________________________________ _______________ _____

(Name: First & Last) (Date of Birth) (Age)

Sex (circle one): male female

Language Level* (circle one): Beginning Intermediate Advanced

Special interests: _____________________________________________________

PROGRAM INFORMATION---Camp Catalina Children’s Programs

(Note: Camp sessions begin on Mondays and end on Fridays.)

Camp Start Date* Day:___________ Month:_____________ Year:_________

Camp End Date* Day:___________ Month:_____________ Year:_________

Number of weeks of study* (circle): 1 week 2 weeks 3 weeks 4 weeks

Other: _____________

Reason for choosing school: ____________________________________________________________________

____________________________________________________________________

Expectations:

____________________________________________________________________

Total Amount of Fees for Camp* (check one):

(This is your estimate only)

__	Weekly Camp Tuition (1^st child)	$135	/wk x	___	wks =	$_______
__	Weekly Camp session (2^nd child – 10% discount)	$122	/wk x	___	wks =	$_______
__	Weekly Camp session (3^rd child – 10% discount)	$122	/wk x	___	wks =	$_______
__	Weekly Materials Cost $25/wk x ___#of children =		/wk x	___	wks =	$_______
*Your estimate of Camp Tuition & Fees due upon arrival:**						$_______

*This estimate is based on at least two participants signed up on a given week. Individual camps can be run for one child only at a higher tuition rate of $270 per week plus materials.

There will be no camp registration fee for children whose parents are registering for our adult immersion classes at the same time. Otherwise, there is a $45 non-refundable registration fee for up to three

children in the same family.