CAMPUS DAY CAMP 2023

2901 Campus Rd. Brooklyn, N.Y. 11210 718.421.7575

Child's Information

Full Name *

Sex *

Male

Female

School *

Birth Date *

Age (by June 29) *

Grade Entering *

Siblings/Age

Known Allergies

Medical Conditions/Restrictions

Special Needs *

Yes

If Yes, Describe

Parent/Guardian Information (1)

Guardian (Relationship) *

Name *

Occupation *

Email *

Address *

Address

City

State/Province

Zip/Postal

Home Phone

Work Phone

Cell Phone *

Parent/Guardian Information (2)

Guardian (Relationship)

Name

Occupation

Address

City

State/Province

Zip/Postal

Home Phone

Work Phone

Cell Phone

Child Pick-up and Emergency Contact Information:

Please list persons with phone numbers whom you give permission to pick-up your child from the program. Please note that we will not release children to anyone not on this list without prior authorization. Children will not be released to anyone under the age of 16.

Contact 1 Name

Relationship

Phone

Contact 2 Name

Relationship

Phone

Contact 3 Name

Relationship

Phone

Contact 4 Name

Relationship

Phone

Camp Fees

Tuition

Grade Entering	Full Summer9:00am - 4:15pm	One Session9:00am - 4:15pm
Adventurers K-2^nd Grade	1$2,750	2$2,550
Discoverers 3^rd - 5^th Grade	3$2,850	4$2,650
Explorers 6^th - 10^th Grade	5$2,950	6$2,750

CHOOSE TUITION *

Full Summer

One Session

CHOOSE GRADE *

Adventurers Full Summer

Discoverers Full Summer

Explorers Full Summer

CHOOSE GRADE *

Adventurers One Session

Discoverers One Session

Explorers One Session

Additions

Options	Full Summer	One Session
Bus One Way	A$250	B$125
Bus Both Ways	C$500	D$250
Early Drop 7:30am	E$300	F$150
Late Stay 6:00pm	G$300	H$150
Late Stay 7:00pm	I$350	J$175

ADDITIONS *

Bus

Early Drop

Late Stay

No Additions

Bus cannot be selected when both Early Drop and Late Stay are also selected.

Bus and No Additions cannot be selected together.

Early Drop and No Additions cannot be selected together.

Late Stay and No Additions cannot be selected together.

CHOOSE BUS SCHEDULE *

Bus Both Ways

Bus One Way

CHOOSE BUS SCHEDULE *

Bus One Way

CHOOSE BUS SCHEDULE *

Bus One Way

CHOOSE BOTH WAYS BUS OPTION *

Bus Both Ways (Full)

Bus Both Ways (One)

CHOOSE BOTH WAYS BUS OPTION *

Bus Both Ways (One)

CHOOSE ONE WAY BUS OPTION *

Bus One Way (Full)

Bus One Way (One)

CHOOSE ONE WAY BUS OPTION *

Bus One Way (Full)

Bus One Way (One)

CHOOSE ONE WAY BUS OPTION *

Bus One Way (Full)

Bus One Way (One)

CHOOSE ONE WAY BUS OPTION *

Bus One Way (One)

CHOOSE ONE WAY BUS OPTION *

Bus One Way (One)

CHOOSE ONE WAY BUS OPTION *

Bus One Way (One)

CHOOSE BUS TIME *

EARLY DROP *

Early Drop (Full)

Early Drop (One)

EARLY DROP *

Early Drop (One)

LATE STAY *

Until 6:00pm

Until 7:00pm

LATE STAY 6:00PM *

Late (Full)

Late (One)

LATE STAY 6:00PM *

Late (One)

LATE STAY 7:00PM *

Late (Full)

Late (One)

LATE STAY 7:00PM *

Late (One)

Deposit of $500.00 must be paid at time of registration.

Deposit will be applied to camp fee.

Camp must be paid for in full by no later than May 31, 2023

Deposit is non-refundable after May 31, 2023.

Full summer is June 29-August 11. Single session is either June 29-July 21 or July 24-August 11.

Tuition Fee

Additions

Total

Parent/Guardian Consent and Policies

In case of an emergency injury or illness, I authorize the program to call the paramedics. As legal guardian of the above listed student, a minor, I authorize the program representative designee to consent to any x-ray, examination, anesthetic, medical or surgical diagnosis, treatment, and/or hospital care to be rendered upon the advice of any licensed physician and/or dentist.

There will be no refund or pro-rating for absenteeism. It is our policy to charge $5.00 per quarter hour past closing time, which is 4:15 or 6:00 or 7:00 PM. If child is pulled out from program before end of summer no refund will be given.

Rules and regulations must be adhered to at all times. Campus ASP Inc. reserves the right to suspend or expel a child from the program for disruptive or dangerous behavior.

Campus ASP Inc. and its employees are not responsible for personal items.

*We do not have a special needs program. Children may be accepted if they are able to be included within the group and do not require one on one or any other additional services. We require a trial before admission of any child with special needs.

Campus ASP Inc. may at times use your child’s image on promotional items, both in print and online.

I give consent for Campus ASP Inc . to pick up my child and attend trips using our full size school buses, mini buses, passenger vans, minivans/cars or by walking. *

Yes

I give my consent for my child to attend Campus ASP Inc. and participate in its activities and trips . *

Yes

I understand that my child will receive lunch and snack daily. *

Yes

I have read and understand the above

Parent/Legal Guardian Signature *

Clear

Date

If you are human, leave this field blank.

Clear Form

Camp Registration

CAMPUS DAY CAMP 2023

2901 Campus Rd. Brooklyn, N.Y. 11210 718.421.7575

Child's Information

Parent/Guardian Information (1)

Parent/Guardian Information (2)

Child Pick-up and Emergency Contact Information:

Camp Fees

Tuition

Additions

Parent/Guardian Consent and Policies