Summer Camp Registration Form in Norbeck Montessori Summer Camp Registration Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Type of Student * New Student Returnee Academic Year *2024Child's Name *Gender *MaleFemaleChild's Birth Date *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent's Name *Relationship to Child *MotherFatherStep-MotherStep-FatherGrandparentLegal GuardianParent's Mobile Number *Parent's E-mail *Parent's Work PhoneSecond Parent's NameRelationship to ChildMotherFatherStep-MotherStep-FatherGrandparentLegal GuardianSecond Parent's MobileSecond Parent's EmailSecond Parent's Work Phone Allergies, if any *Program Plan *Summer Camp ProgramSummer Camp Program Times & Pricing *Extended Day: 7:30 a.m. – 6:00 p.m. Price: $375.00 per week.Full Day: 8:00 a.m. – 3:30 p.m. Price: $350.00 per week.Half Day: 8:45 a.m. – 12:15 p.m. Price: $300.00 per weekMontessori Instruction Program Times & Pricing *Extended Day: 7:30 a.m. – 6:00 p.m. Price: $425.00 per week.Full Day: 8:00 a.m. – 3:30 p.m. Price: $375.00 per week.Half Day: 8:45 a.m. – 12:15 p.m. Price: $325.00 per week.Weeks of Attendance and Themes7/1-7/5 Theme USA (Norbeck will be closed on 7/4 for Fourth of July)8/12-8/16 Theme What a Mess! (Norbeck will be closed on 8/16 for a Professional Day)I Agree to Below *I have included a $200 NON-REFUNDABLE Deposit.Program Payment *I understand additional childcare is available for children in Half day and Full Day. The additional fee per hour for children in Half day or Full day is $11.00.Sessions Selection *I have checked all the sessions I wish to reserve for my child. I realize I will be billed for each session I have reserved unless I submit written notice to Norbeck Montessori. This notice must be received two weeks in advance. NOTIFYING A STAFF MEMBER DOES NOT CONSTITUTE PROPER NOTICE. *NOTE: No allowances can be made for absences due to illness, disability or change in personal plans. My Child Wears Diapers *YesNoMy Child is in Underwear All Day. *YesNoSignature * Clear Signature Signature is Required Total Amount *Price: $200.00Non-refundable deposit for the summer camp Application for your child in Norbeck Montessori.My Child Wears Pull Ups *YesNoMy Child will take a Nap at Camp After Lunch (Toddler Room Only). *YesNoDate *Stripe Credit Card *Submit
