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All Star Kids Camp 2015 Registration
Weekly rate includes lunch and snack every day
Session #:
Dates:
# of Kids:
1
May 26-29
2
June 1-5
3
June 8-12
4
June 15-19
5
June 22-26
6
June 29-July 3
7
July 6-10
8
July 13-17
9
July 20-24
10
July 27-31
11
Aug 3-7
Price per child:
Member – $185
Non. – $215
Member – $148
Non. – $172
Before Care:
After Care:
(please circle)
(please circle)
$30 8-9am
$50 3-6pm
10 % discount for enrollment in 9 or more sessions
–$
10% discount for enrollment of second child
–$
Daily Rate: Member – $55 per day, Non-member – $60 per day
Name – 1st Child
Sub Total
TOTAL
T-shirt Size (please circle) Child: S M L
Adult: S M L
T-shirt Size (please circle) Child: S M L
Adult: S M L
Date of Birth
M
Name – 1st Child
Date of Birth
Address
Email Address
Phone Number
Method of Payment (please circle):
Check (enclosed)
Charge to Member Account # ___________
Credit Card (provided below)
Credit Card #: __________________________________________________________________ Exp. ___________
I authorize the Chesterfield Athletic Club to charge my member account (if applicable). A $50 non-refundable fee per child is due at sign-up
and will be deducted from your total Kids Camp charge. In order to receive the 10% discount for nine sessions or a second child, you must
submit payment in full by June 1, 2015. NO REFUNDS will be provided for no-shows.
Name of Parent/Guardian (please print)
Signature
Date
16625 Swingley Ridge Rd.
Chesterfield, MO 63017
636.532.9992
www.chesterfieldathleticclub.com