SUMMER 2004 ENRICHMENT REGISTRATION FORM
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Check one |
‚ Language, Arts and Crafts Camp |
‚ Computer Camp |
| Student’s Name: |
|
Grade
Completed 03/04: |
|
School District
(other than Harwich) |
|
| Parent/Guardian: |
|
Home Tele |
|
| Work Tele: |
|
Cell Phone: |
|
| Mailing Address: |
|
| |
| Emergency Contacts: Please list individuals who
will assume responsibility for your child in the event you cannot
be reached |
| Name: |
|
Phone: |
|
| Name: |
|
Phone: |
|
| Medical/Behavioral Concerns or Allergies: |
| |
| |
Please return with payment to:
HCLCP, Summer Enrichment, P.O. Box 759, Harwich Port, MA 02646
or
Bring to our office @ the Harwich Elementary School on 263 South
Street, Harwich |
| Payment Enclosed |
Language, Arts and Crafts :$375.00
‚Check
# __________ ‚Cash |
| |
Computer Camp $150.00
‚ Check #__________ ‚ Cash |
Refunds or credits in full will be granted
if course(s) must be canceled due to under-enrollment. Refunds
will be given if students withdraw at least one week prior
to the start of the course, minus a processing fee of $25.00.
No other refunds will be granted as this is a fee funded program,
with fees committed to class once it starts.
The Harwich Public School District does not discriminate
on the basis of race, sex, religion, national origin, sexual
orientation or disability. |
