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Summer On Site Camp Registration Form
Please fill out this form completely and return it to the Front Desk at GBBGC. A full payment must be submitted at
the time of registration. If you would like a payment plan, then a $150 deposit must be submitted in
order to secure the spot. Please make sure that any outstanding balances are paid.
Please go by the grade your child completed as of June 2015.
Member Information
First Name: ___________________________ Last Name: _________________________ Grade as of June 2015: ____________
Home Phone: ______________________ Cell Phone: _______________________ Work Phone: _________________________
Home Address:_______________________________________ Town: ______________________ Zip Code:_______________
Parent Information
1. Parent/Guardian First Name:_______________________ Last Name:_____________________ Phone: ________________
2. Parent/Guardian First Name: _______________________ Last Name: _____________________ Phone: ________________
Would you like to be considered for a payment plan? (Circle One)
T-Shirt Size (Please Circle):
Youth: S M L
Yes
Adult:
No
S M L XL 2XL
Circle the camp and weeks you are registering for:
Little Gators Grades 1-3 ……………………..$150
Junior Gators Grades 4-6………………..…..$150
Week 1..…July 13th - 17th
Week 4..….Aug. 3rd - 7th
Week 1..…July 13th - 17th
Week 4..….Aug. 3rd - 7th
Week 2......July 20th - 24th
Week 5..….Aug. 10th - 14th
Week 2......July 20th - 24th
Week 5..….Aug. 10th - 14th
Week 3…..July 27th - 31st
Week 6...…Aug. 17th - 21st
Week 3…..July 27th - 31st
Week 6..…Aug. 17th - 21st
Total Amount of Weeks Circled _____________
Total Amount of Weeks Circled _____________
Extended Day……………………..……….…..$50
Week 1..…July 13th - 17th
Week 4..….Aug. 3rd - 7th
Total Amount of Weeks: _________________
Week 2......July 20th - 24th
Week 5..….Aug. 10th - 14th
Total Amount of Extended Day: __________
Week 3…..July 27th - 31st
Week 6...…Aug. 17th - 21st
Total Amount Due: ______________________
Total Amount of Weeks Circled _____________
Please consider making a donation to support The Club $25___ $50___ $100___ Other: $____
__________________________________________
__________________________________
Parent Signature
Date
For Office Only:
Payment Method: ________________ Deposit Paid: __________ Other Registrations: ___________________ Cashier: _________