Camp MELC Colonial Application – New 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? * Yes No Please select one. 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 XLARGE 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) COMPLETE YOUR APPLICATION FEE PAYMENT ON THE NEXT PAGE: In order to complete the registration process for this session you'll need to complete a payment for the $25 application fee on the next page. If this payment is not completed, your application will not be accepted Application Fee (Required) If you are a human and are seeing this field, please leave it blank.