Summer Camp

Medina Montessori
Summer Camp
Registration Form
June 25th - August 17th - children ages 3-7

* Indicates required field

STUDENT NAME *

First

Last

GENDER *

MALE FEMALE

Languages Spoken at Home *

AGE *

ADDRESS *

Line 1

Line 2

City

State

Zip Code

Country

BIRTH DATE *

Home Phone *

Name of any other school/program student attended: *

Select One or Both *

Session 1 : June 25 - July 20 Session 2: July 23 - August 17 Specific Week(s)

Select Your Schedule (Mon-Fri) *

Primary Half Day - 8:30AM-12:00PM - $825/session Standard Day - 8:30AM - 2:15PM - $1185/session Full Day - 8:30AM - 5:00PM - $1390/session

Father's Name *

First

Last

Mother's Name *

First

Last

Cell Phone *

Email *

Submit