2019 Summer CAMP DATES & PAYMENT

Camper Information
Camper's Name * First Last
Birthdate * MM / DD / YYYY
Child's Age *
School Camper Attends *
Does the camper have any allergies? *
No Yes, list any and all below.
Family Information
Parent/Guardian #1:

The confirmation email will be sent to this adult.
Parent/Guardian #1 * First Last
Cell Phone Number * ### - ### - ####
Email Address *

The confirmation email will be sent to this address.
Week Camper Will Be Attending

Mark each week your child will be attending, EVEN if your child is coming for individual days that week. For single days, select the week, then enter your specific date(s) below our list.
2019 Summer Camp Dates *
May 27-31 [Memorial Day, 27th] June 3-7 (4th & 6th: schools closed) June 10-14 (11th: schools closed) June 17-21 June 24-28 July 1-5 [Independence Day, 4th] July 8-12 July 15-19 July 22-26 July 29-Aug 2 Aug 5-9 Aug 12-16 Aug 19-23 Aug 26-30 Sep 2-6 (Labor Day, 2nd: No Camp)) Sep 9-13 Sep 16-20

If you are attending for DAYS not the whole week, SELECT THAT WEEK and then write in the days at the bottom of the list. You MUST mark the week so we know when you are attending!! Write the individual dates as well.

Specific Dates

If you checked an entry above that has a multiple dates, enter the exact dates you need here. If the date you need is not listed above, enter that date here.

Payment For Camp Day(s)

$140 per day or $625 for a 5 day week.
Please select the number of days your child will attend below.

Select the number of days your child will attend: *

Optional: Coding

Select the number of hours of coding you need (one per day). Coding class is 1 hour

Coding: Number of Days

Select the number of days you would like your child to participate in the coding class.

Coding: list dates

Please list the exact dates your child will participate in the coding class.

Optional: Early or After Camp Care

For each day listed below, select the number of hours of extra care you need.

Early Care is available from 8:00AM to 9:00AM
After Care is available from 3:00PM to 6:00PM

Extra Care is $15 per hour.

You will be charged by the hour for extra care.

Do you need Extra Care? *

Yes No

Please keep in mind that we charge for full hours, on the hour. You may pick up/drop off your child at any time within that hour., Extra Care hours (8am-9am and 3pm - 4pm, 5pm, 6pm).

List exact DATES and TIMES for ExtraCare (8-9, 3-4, 3-5, 3-6 etc)

Please let us know which extra hours you need. If you put 1 hour above, tell us which hour. (8am - 9am OR 3pm - 4pm)

PAYMENT INFORMATION - choose from the options below

Complete the cost information below. You will receive an invoice and payment instructions. Please note that credit card payments will include a 3.5% processing fee.

PAYMENT METHOD

Payment method for camp and optional after care: *

Credit Card (will include 3.5% processing fee) Check Cash

If you choose any option you will be sent an email with instructions about how to pay and/or where to send or bring payment.

General Waiver and Release

By entering my name below, I understand that I am authorizing Dazzling Discoveries to collect payment for camp weeks listed above. I understand that all payments are NOT REFUNDABLE. I understand that weeks may be transferable within a two month range if there is space. Transfer must be requested at least one week prior to the originally scheduled camp date. I understand that if my child is ill during the camp week and can not finish the week that those dates are NOT transferable.

I agree that Dazzling Discoveries, its agents and employees shall not be liable to me or my child for any injury or damage, howsoever caused, resulting directly or indirectly from my child's participation in the Dazzling Discoveries classes at any time preceding, during or after camp is in session and I hereby discharge Dazzling Discoveries, its agents and employees from all actions, claims and demands I or my child may have for any such injury or damage. I authorize that Dazzling Discoveries has the right to use all photographs or videos taken of my child during class for advertising or promotional purposes.

Signature * Title First Last Suffix

To agree, type your name to sign.

Date * MM / DD / YYYY

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Camper Information

Family Information