St. Vincent's One Nineteen Health and Wellness

2008 Kids Day Camp
PAY DEPOSIT ONLINE NOW TO RESERVE A SPACE FOR YOUR CHILD TODAY!

Child 1 Name: Child 1 Age: Child 1 T Shirt Size:

Child 2 Name: Child 2 Age: Child 2 T Shirt Size:

---------------------------------------------------------------------------------------------------------------------------------------------------

Parent 1 Name:

Parent 1 Phone: - (###-###-####) Email:

Parent 2 Name:

Parent 2 Phone: - (###-###-####) Email:

---------------------------------------------------------------------------------------------------------------------------------------------------

Legal Guardian Name: Legal Guardian Phone: - (###-###-####)

Legal Guardian Email:

Dates Attending Camp: (i.e. 7-8-08 or 7-8-08,7-9-08 for more than 1 day)

Do you wish to pay your deposit online? Yes No

2008 Kids Day Camp Registration Please fill in your relevant information only.

2008 Kids Day Camp Registration
Please fill in your relevant information only.