2015 HALF DAY Triple A Summer Camp REGISTRATION FORM PLEASE PRINT CAMPER NAME_________________________________________ M/F______ ADDRESS______________________________________________________________ CITY___________________________STATE___________ZIP____________________ DATE OF BIRTH__________________ AGE________GRADE ENTERING _________ PARENT’S NAME________________________________________________________ EMAIL ADDRESS________________________________________________________ HOME PHONE_____________________CELL_________________________________ PARENT’S SIGNATURE___________________________________________________ FEE___________CASH_________CHECK #___________________________________ CREDIT CARD (CIRCLE ONE) VISA or MASTER CARD or DISCOVER CREDIT CARD #___________________________________EXP: _______ SEC. CODE: _________ PLEASE MAKE CHECKS PAYABLE TO: TOWNSHIP OF EVESHAM MAIL TO: 984 TUCKERTON ROAD, MARLTON, NJ 08053 or IN PERSON: GIBSON HOUSE 535 E. MAIN ST. (8 a.m. – 4 p.m.) ONLINE: www.evesham-nj.org and click link to online registration Department of Recreation & Senior Services Mailing Address: 984 Tuckerton Road, Marlton, New Jersey 08053 In Person Registration: Gibson House, 535 E. Main Street Phone: (856) 985-9792 Fax: (856) 985-2878 The fee is for the length of the half day summer camp. For a receipt, please enclose a self-addressed, stamped envelope or your email address. There are no refunds after the start of summer camp. Fees will NOT be pro-rated after camp has started. A $25 administrative fee will be charged for any cancellations. Non-residents, please add a $25 annual family fee to the cost.