Culture Camp 10509

Registration Form
Home Up Schedule Featured Workshop

Culture Camp Southeast Recreation Department, Brewster, NY, 10509

 

For Printable Version click here

Culture Camp Registration Form

Camper’s name: ___________________________Age:____Telephone:____________

Address: ______________________________Work Telephone 1) ________________

Parent/Guardian name:____________________Work Telephone 2) _____________  

Email (please print): _____________________________________________________

Total amount (number of weeks X $155) : $___________**(non-residents please add 10%)    

 **Please pay materials fees to instructors on the first day of camp.

_____________________________has my permission to attend Culture Camp offered by the Town of Southeast.  It is the applicant’s responsibility to pay for his/her own medical insurance coverage.  The applicant herein acknowledges the above and releases the Town of Southeast from any and all liability for medical incurred due to injury from this activity.  ALL FEES ARE NON-REFUNDABLE.

 PARENT/GUARDIAN SIGNATURE___________________________________________________________

 

 

1st Hour

2nd Hour

3rd Hour

July 5:

 

 

 

July 12:

 

 

 

July 19:

 

 

 

July 26:

 

 

 

Aug 2:

 

 

 

 

Home ] Up ] Schedule ] Featured Workshop ] [Registration Form]

Send mail to contactus@culturecamp10509.com with questions or comments about this web site.
Copyright © 2009 Culture Camp
Last modified: 05/02/10