Summer Camp
Registration for Summer 2012

Parent's First Name*:

Parent's Last Name*:

Street Address*:

City*:

State*:

Zip*:

Home Phone*:

Cell Phone:

e-Mail Address*:

Work Phone:

Child's First Name*:

Child's Last Name*:

Age*:

School Grade*:

Summer Camp 2012
Attendance Schedule:

Week 1: June 18 -- June 22
Week 2: June 25 -- June 29
Week 3: July 2 -- July 6
Week 4: July 9 -- July 13
Week 5: July 16 -- July 20
Week 6: July 23 -- July 27
Week 7: July 30 -- August 3
Week 8: August 6 -- August 10
Week 9: August 13 -- August 17
Week 10: August 20 -- August 24

Transportation Arrangements:
My child will ride Lyceum's bus between Glen Mill Center, Summer Camp and Lakewood ES
I will make my own arrangements to drop off and pick up my child

Comments:

The electronic registration is not final and does not guarantee your child's enrollment. To finalize enrollment a deposit covering the cost of the last week of attendance is required. Please send all required documents and a deposit check made payable to Vladimir Gurevich to:
13544 Glen Mill Rd, Rockville MD 20850

Summer CampRegistration for Summer 2012

Summer Camp
Registration for Summer 2012