Get into the Summer Spirit! - Harns Marsh Elementary School

Harns Marsh Elementary
Dawn to Dusk
Get into the Summer Spirit!
Where: 1800 Unice Avenue North
Lehigh Acres, FL
What: (9 week) Summer Camp Program
For Students Grades K-5th
When: June 8th -August 7th
Time: 7am -6pm (Monday- Friday)
FOOD: Lunch and Snack
will be provided.
*Please note breakfast will not be served
PRICE: $35 registration fee per family
$75 per week for the first child
$65 for each additional sibling
Fun Activities Include:
Arts and Crafts, Computer Classes, Cooking, Field Trips,
Science Activities, Sport Activities, Water Games, Guest Speakers.
If you have any questions please call and contact Ms. Dali Cruz at 239-690-1249.
Harns Marsh Elementary
Dawn to Dusk Summer Camp 2015 Registration Form
Registration Fee: $35 per family (Non-Refundable) CHECK ( ) or CASH ( ) only
First Child’s Last Name: _____________________________
Birth Date __________________
First Name:_____________________________________
Gender:_______________
Second Child’s Last Name: __________________________
Birth Date:__________________
Grade: _________________
First Name:_____________________________________
Gender: _______________
Third Child’s Last Name: ____________________________
Birth Date: __________________
Grade: _________________
First Name:_____________________________________
Gender: _______________
Grade:_________________
Mother’s/Guardian’s Name __________________________________________________________________________
Home Address _____________________________________________________________________________________
Street
Home Phone (
City
Zip Code
) _____________ Work ( ) ________________ Cell (
) ________________
Father’s/Guardian’s Name ___________________________________________________________________________
Home Address _____________________________________________________________________________________
Street
Home Phone (
City
) _______________ Work (
Zip Code
) ________________ Cell (
) __________________
Custody Restrictions ( ) yes ( ) no Please provide custody papers
Authorized Persons Permitted to Remove Child (ren) from Program Other than Parents/Guardian:
__________________________________________________________________________________________________
Name
Phone
Relationship
__________________________________________________________________________________________________
Name
Phone
Relationship
___________________________________________________________________________________________________
Name
Phone
Relationship
Special Instructions: (allergies, medications, etc.)___________________________________________________________
___________________________________________________________________________________________________
I have read the Dawn to Dusk brochure and understand the program rules and my responsibilities toward fees, payments, refunds,
etc. Parent Signature_________________________________________ Date __________
*All fees must be prepaid Friday morning or afternoon for the following week.
03/15