Name
Date of Birth
Name
Email
Phone
Address
Name (Contact 1)
Phone
Name of second child
Date of Birth (second child)
Current School Grade
Do any of your registrants have any allergies, chronic illness, or medical conditions?
Are you interested in sponsoring a child to come to CAMP SHINE?
Morning Summer Sessions ($474.05 per session per child reflects 5% discount)
Morning Summer Sessions ($948.10 per session for 2 children reflects 5% discount)
Morning Summer Sessions ($1896.20 per session for 4 children reflects 5% discount)
Wyatt Klopp-Niemi
11/17/2014
John Klopp
klopp@pacbell.net
+14158612171
1300 Merrithew Dr Martinez, CA 94553 US
John Klopp
(415) 861-2171
First Grade
No
No thanks.
*Bonus Session - May 31 - June 3 - $ 424.15 Session 1 - June 6-June 9 - $ 424.15 Session 3 - June 20-June 23 - $ 424.15 Session 4 - June 27-June 30 - $ 424.15 Session 5 - July 11-July 14 - $ 424.15 Session 6 - July 18-21 - $ 424.15
Perri Hutchins
6/19/2012
marni hutchins
marnidyer@hotmail.com
+19252607043
232 NETHERBY PL Pleasant Hill, CA 94523 US
David Hutchins
(925) 286-4684
Marlowe Hutchins
6/2/2015
Fourth Grade
No
No thanks.
Session 3 - June 20-June 23 - $ 848.30
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