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 Summer 2015 Registration Form Please print, complete, & return this form, along with payment, to: The Manitou School, 1656 Route 9D, Cold Spring, NY 10516 Child Information Last Name First Nickname (if any) Middle Date of Birth Attending (check all that apply): ☐ Week 1 (6/29-­‐7/3) ☐ Week 2 (7/6-­‐7/10) ☐ Week 3 (7/13-­‐7/17) ☐ Week 4 (7/20-­‐7/24) ☐ Week 5 (7/27-­‐7/31) Cost per Session: $250. Payment included of :________________ Applicant’s Parent/Guardian: Last Name First City State Cell Phone email Address Home Address Zip Code Home Phone About Your Child Help us learn more about your child by responding to the following questions. Describe your child in three to five words: _________________________________________________________ How does your child learn best? ________________________________________________________________ ___________________________________________________________________________________________ What are your child’s special talents, interests, and abilities? _________________________________________ ___________________________________________________________________________________________ My child is allergic to: _________________________________________________________________________ Agreement: We agree to join in the fun! Parent Signature ________________________________ Date ___________ Manitou ~ 1656 Route 9D, Cold Spring, NY 10516 p 845.809.5695 e [email protected]
www.manitouschool.org