Summer Enrichment Program

Step 1 of 4

Summer Camp Registration Form

The cost for each camp is $425 per child/session requiring a non-refundable deposit of $175. If two or more siblings living in the same household are participating, the discounted cost for each camp is $410 per child requiring a non-refundable deposit of $150 each (please fill out one registration form per child). Registrations will be consider ed on a first come / first serve basis once deposit is received. Words In Motion reserves the right to cancel any program due to insufficient enrollment. No early drop off or late pick up will be permitted. A $25 fee per day will be accrued pick up later than 10 minutes.

Childs Name(Required)

First Last

Parent or Gaurdian Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email(Required)

Enter Email Confirm Email

Date of Birth

Emergency Contact

First Last

Emergency Contact Phone Number

Enroll in our Summer Camp

Summer Camp Registration Form

Medical Background Information

Verbalization

Credit Card

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