GRACE
Episcopal Church and Day School
SUMMER CAMP 2017 REGISTRATION FORM
Children Age 3 - 9
Younger children should have completed a nursery school program and are toilet trained.
Sign up weekly. Or, save and sign up for all six week by June 15th.
I would like to enroll my child
9:00am - 3:00pm Monday thru Friday
9:00am - 12:00pm Monday thru Friday
Session 1 July 10 - July 14
$300 []
Session 2 July 17 - July 21
$300 []
Session 3 July 24 - July 28
$300 []
Session 4 July 31 - Aug. 4
$300 []
Session 5 Aug. 7 – Aug. 11
$300 []
Session 6 Aug. 14 – Aug. 18
$300 []
SESSIONS 1 through 6
$1,650 []
Session 1 July 10 - July 14
$200 []
Session 2 July 17 - July 21
$200 []
Session 3 July 24 - July 28
$200 []
Session 4 July 31 - Aug. 4
$200 []
Session 5 Aug. 7 – Aug. 11
$200 []
Session 6 Aug. 14 – Aug. 18
$200 []
SESSIONS 1 through 6
$1,000 []
Child’s Name __________________________________ Age ______________
$300 Deposit Non-refundable
Total tuition must be paid in full prior to child starting camp
Checks payable to Grace Day School (memo line – Summer Camp). Camp tuition may be put on
your credit card. Forms available upon request. Mail to:
Mrs. Lorraine Brucato
Grace Summer Camp
23 Cedar Shore Dr.
Massapequa, NY 11758
Questions, call 516.798.1122 ext. 18.
23 Cedar Shore Drive, Massapequa, New York 11758
(516) 798-1122
www.gracedayschool.org
CAMPER INFORMATION
Print Clearly
Child’s Name _______________________________________ Male __ Female __
Age as of June 30, 2017 ____
Grade entering _____________
Birthdate __________
School attended last year_______________
Family and Emergency Info:
Parent/Guardian Name ______________________ Relation ____________________
Home Address ____________________________ Home Phone _________________
Cell phone ___________________
Cell Phone _________________________
Work number __________________
Work Phone _______________________
Email ________________________
Name & number of family member, friend, babysitter who may
be notified in the event of an emergency
___________________________ ______________________
___________________________ ______________________
Medical information:
Allergies _____________ none ___
If so, explain
____________________________________________________
____________________________________________________
Completed form and check to: Ms. Lorraine Brucato
Grace Summer Camp
23 Cedar Shore Dr.
Massapequa, NY 11758
23 Cedar Shore Drive, Massapequa, New York 11758
(516) 798-1122
www.gracedayschool.org
23 Cedar Shore Drive, Massapequa, New York 11758
(516) 798-1122
www.gracedayschool.org