Time To Clay 2010 Summer Camp Registration Form

Please check the date/ dates of the sessions you wish to attend.

One Day Mini Camps

Bar-B-Q Grill Plate                  July 6^th _____ or July 29^th _____

Child’s Name: _____________________  Parent’s Name: _________________

Address : _________________________City/ State : ______________________

Phone # : _______________________ Cell # : _______________________

E-mail : ______________________________

Birth Date : _________________________ Age : ______________

List Medical Conditions/ Allergies______________________________________

Emergency Contact Name : ______________________ Phone # _____________

Day Session payment is due at registration. Please check off the session your child will be attending and enclose payment.

Multi Day Sessions- $50.00 deposit due at  registration. Balance due on the first day of camp session.

Refund Policy- Full refund will be issued for cancelations requested 14 days prior to session date.

I hereby declare that I have filled out the above information to the best of my knowledge and have informed staff of all information needed in case of emergency. I understand the refund policy.

Parent Signature : ______________________________ Date: __________

Mail form and payment to:  Time To Clay    228 Daniel Webster Highway    Nashua, NH 03060