APPLICATION FOR 2016 SUMMER PROGRAM
For children 3-6 YEARS OLD
Application date:
How did you hear of our camp (thank you for being as specific as possible)?
Friends/word of mouth (who?):
Promotional materials (what and where?):
Other:
Child’s Information
Name:
Usually Called:
Birthday:
Child’s age on 6/20/16:
Child is:
Male Female
Does your child speak any foreign languages at home?
If yes, which languages?
Parents’ Information
Parent’s name:
Address:
Cell:
Email:
Occupation:
Employer:
Business address:
Business phone:
Parent’s name:
Address:
Cell:
Email:
Occupation:
Employer:
Business address:
Business phone:
Please list anyone else with permission to pick up your child from camp:
newamsterdamschool.org
62AvenueB(between4th&5th)NewYork,NY.(212)982-1400
Please list any medical issues or food allergies that are not detailed on the attached medical
form that we should be aware of.
Dates and Payment
The cost for each week is $500. A minimum of two weeks is required for enrollment. A 10%
discount is available for those who register by April 30, 2016. The discount will be applied only
to the weeks confirmed by April 30. If subsequent weeks are added at a later date, no discount
will apply. A non-refundable $50 registration fee is due along with 50% of your summer
program payment at the time of registration.
Please circle the weeks you would like to attend:
Week 1, 6/20-6/24 $500
Week 2, 6/27-7/1
$500
Week 3, 7/5-7/8*
$400
Week 4, 7/11-15
$500
Week 5, 7/18-22
$500
Week 6, 7/25-29
$500
Week 7, 8/1-5
$500
Week 8, 8/8-12
$500
Registration Fee
$50
* July 5th-8th will be a four day week.
Total Number of Weeks______x $500=________
Less 10% discount for early bird sign up (on or before April 30):________
Subtotal________
Registration fee for new families (non-refundable)+__$50___
Total Amount Due________
newamsterdamschool.org
62AvenueB(between4th&5th)NewYork,NY.(212)982-1400
Payment of non-refundable $50 registration fee for families not currently
enrolled at the school is required. Please submit the registration fee and
50% of the program fee along with your registration.
Health Record
Please fill out the attached health form in its entirety and submit it along with this application
and a check for the amount due payable to New Amsterdam School.
Please deliver you application materials to:
Office of Admissions -- Summer Program
New Amsterdam School
62 Avenue B
New York, NY 10009
Questions can be directed to Kaarin: [email protected]
2016 Summer Program Terms and Conditions
I understand and agree:
1. that this payment is for $500 per week for a two week minimum participation
in the 2016 summer camp program and that I shall not be entitled to any deduction for my
child’s absences or illnesses during the term; that in the event of my child’s withdrawal or
suspension from the summer camp program after classes have started, I shall not be entitled to
any refund of unused tuition;
2. that the program requires my child to meet certain standards of behavior and that if my child
fails to meet these standards of behavior or demonstrates repeated unsatisfactory conduct,
New Amsterdam School has a right to dismiss my child from the summer program;
3. that if my child is not picked up by the end of the program (1:00pm) I agree to pay lateness
fees according to School policy;
newamsterdamschool.org
62AvenueB(between4th&5th)NewYork,NY.(212)982-1400
4. that if my child is injured and requires medical attention and I cannot be reached for
instructions, I do hereby give authority to the New Amsterdam School to obtain necessary
emergency medical treatment for my child with the understanding that the family will be
notified as soon as possible;
5. that by allowing my child to participate in the New Amsterdam Summer Program, I hereby
release the New Amsterdam School, the Summer Program, and all employees, volunteers,
contractors and agents of the program from any liability arising out of or based upon any bodily
injury or property damage which may be sustained by my child while participating in the
program.
Parent / Guardian
Signature:____________________________________ Date:_________________
Parent / Guardian
Signature:____________________________________ Date:_________________
Friends of the New Amsterdam School is a 501 (c) 3 tax-exempt public charity with tax id 26-2407285.
We admit students of any race, color, national and ethnic origin to all privileges, programs and activities generally
accorded or made available to students at the school.
newamsterdamschool.org
62AvenueB(between4th&5th)NewYork,NY.(212)982-1400