Camp MELC Colonial Application – Current Families If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required. School Child Attends * Grade As Of September 2017 * Child's Name * Gender * Please select one. Male Female Birth Date * Address Where Child Resides * City * State * Zip Code * Child Resides With * Both ParentsMotherFatherOther If other, please specify PARENT/GUARDIAN 1 INFORMATION Name * Home Phone * Cell Phone * Email * Home Address * City * State * Zip Code * Employer/Workplace * Work Address * Work Phone * PARENT/GUARDIAN 2 INFORMATION Name * Home Phone * Cell Phone * Email * Home Address * City * State * Zip Code * Employer/Workplace * Work Address * Work Phone * How Did You Hear About Camp MELC? * Please select one. CCIS Currently enrolled child Facebook Google Search Mainline Media School District Word of mouth Other If you selected other, please specify: Please briefly describe any special needs, allergies or disabilities of your child. * Does your child have an IEP? * Please select one. Yes No Do you have CCIS? * Please select one. Yes No T-Shirt Size * Please select one. Child Size XSMALL Child Size SMALL Child Size MEDIUM Child Size LARGE Adult Size SMALL Adult Size MEDIUM Adult Size LARGE Adult Size X-LARGE Please select the session(s) needed. Camp Fee Per Session - $720 *Fee includes a maximum 10 hours of care daily and all activities and trips. *Additional weeks can be added to any session for a fee of $240/week. Please contact Center Director for more information. Early Bird Discount: Register by May 2nd and receive a 5% tuition discount All Summer Discount: Pay in full by June 14th and receive a 3% tuition discount Choose Your Session(s) * You may select multiple camp sessions. Use Control + Shift on your keyboard to select multiple sessions. Session 1 (June 19-July 7) Session 2 (July 10-July 28) Session 3 (July 31-August 18) If you are a human and are seeing this field, please leave it blank.