Claire Golden Drake-Program Director
John Doyle, Advisor
Montgomery County Cultural Center
208 DeKalb Street, Norristown, PA 19401
Registration Application 2011: Kids: The Heart of the Arts Summer Camp
Name:_______________________________ Age _______ Home Phone_____________
Address______________________________Town_____________State______Zip_____
Parents Name(s)____________________________Cell or Work Phone_______________
Parents E-mail_____________________________Returning Student ____ New Student___
Emergency Contact_____________________________Phone___________________________
Registration requirements include:
#1- A referral from a teacher or administrator at your child�s school,
#2- The child must write a short paragraph about why he/she would like to addend this program. If the child is too young to write this please let him/her dictate it to you. You can use the back of this form for the paragraph.
#3- Have your child tell us what area of the arts is their favorite. They may circle one or more areas here. Theater Art Music Dance.
If you have more than one child please copy this form or on another sheet of paper list other children�s information that you want to have them considered for the program or call for another form.
The camp is for ages 5 - 14 years old.
This tuition covers the entire program from June 27 -July 29, 2011 There is also a one time a year $25 registration fee per family.
If your child(ren)want to attend other classes throughout the year there will not be another registration fee. This is a family fee and does not have to be paid for each child.
Tuition: Check the choice that you want:
___Choice #1-9AM � 1:15 PM-$370,We provide a drink, student brings snack
___Choice #2-9AM-3:15 PM- $400,We provide a drink, student brings snack & lunch
___Choice #3- 9AM-5:15 PM-$430,We provide a drink, student brings snack & lunch
The deposit for the camp for all the above choices is $40 per child. Please enclose it when you send the registration form. We take cash (bring that in, do not mail), check, credit card-Visa and Mastercard only, or money order.
We are also offer a pay plan. If you are interested mark here.
___ I will pay by check.
___ I will pay by money order.
___ I will pay by cash and will bring the registration to the Cultural Center
___ I will pay by credit card. Name:__________________Phone __________________
Circle one: Visa Mastercard.
Name:__________________Phone Number___________________
Account number_______/________/________/_______
Expiration Date_________
Security Number (3 digits on back of card)___________
For information call: (610) 279-1013
