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Summer Day Camp (Ani)
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Summer Day Camp (Ani)
Summer Day Camp (Ani)
nimda
2018-08-27T10:39:14-07:00
Please select 1st time registering for 2018 to get started!
*
1st time registering in 2018
Returning for additional week(s)
Child's Name
*
First
Last
Gender
*
Male
Female
Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
*
(a copy of this form will be sent to this email)
Birth Date
*
MM slash DD slash YYYY
Grade in August 2018
*
Father's Name
*
First
Last
Cell
*
Work Phone
Occupation
*
Company Name
*
Mother's Name
*
First
Last
Cell
*
Work Phone
Occupation
*
Company Name
*
Emergency Contact (parent unavailable)
*
Relationship to Child
*
Phone
*
Member of Homenetmen Glendale "Ararat" Chapter
*
Yes (active member with fully paid membership)
No
10% "member" discount is reflected in the total below.
Payment Options
*
Pay in full now
Pay in person by check or cash
There will be an additional $15 for Wednesday Field Trips
Payment Options
*
Pay in full now
There will be an additional $15 for Wednesday Field Trips
Week 1 - Sold Out
June 11-June 15
Sold Out
Please select which days the child will attend
*
June 11
June 12
June 13
June 14
June 15
Please select which days the child will attend
*
June 11
June 12
June 13
June 14
June 15
Week 2 - Sold Out
June 18-June 22
Sold Out
Please select which days the child will attend
*
June 18
June 19
June 21
June 22
Please select which days the child will attend
*
June 18
June 19
June 21
June 22
Week 3
June 25-June 29
2 Days ($150)
3 Days ($200)
4-5 Days ($250)
Not Selected
Please select which days the child will attend
*
June 25
June 26
June 27
June 28
June 29
Please select which days the child will attend
*
June 25
June 26
June 27
June 28
June 29
NO CAMP 4th of July Week: July 2-July 6
Week 4
July 9-June 13
2 Days ($150)
3 Days ($200)
4-5 Days ($250)
Not Selected
Please select which days the child will attend
*
July 9
July 10
July 11
July 12
July 13
Please select which days the child will attend
*
July 9
July 10
July 11
July 12
July 13
Week 5
July 16-July 20
2 Days ($150)
3 Days ($200)
4-5 Days ($250)
Not Selected
Please select which days the child will attend
*
July 16
July 17
July 18
July 19
July 20
Please select which days the child will attend
*
July 16
July 17
July 18
July 19
July 20
Week 6
July 23-July 27
2 Days ($150)
3 Days ($200)
4-5 Days ($250)
Not Selected
Please select which days the child will attend
*
July 23
July 24
July 25
July 26
July 27
Please select which days the child will attend
*
July 23
July 24
July 25
July 26
July 27
Week 7
July 30-August 3
2 Days ($150)
3 Days ($200)
4-5 Days ($250)
Not Selected
Please select which days the child will attend
*
July 30
July 31
August 1
August 2
August 3
Please select which days the child will attend
*
July 30
July 31
August 1
August 2
August 3
Week 8
August 6- August 10
2 Days ($150)
3 Days ($200)
4-5 Days ($250)
Not Selected
Please select which days the child will attend
*
August 6
August 7
August 8
August 9
August 10
Please select which days the child will attend
*
August 6
August 7
August 8
August 9
August 10
Week 9
August 13- August 17
2 Days ($150)
3 Days ($200)
4-5 Days ($250)
Not Selected
Please select which days the child will attend
*
August 13
August 14
August 15
August 16
August 17
Please select which days the child will attend
*
August 13
August 14
August 15
August 16
August 17
FULL PAYMENT FOR THE WEEK IS DUE BY FRIDAY OF THE PREVIOUS WEEK. If deadline is not respected, there will be a $20 late fee.
I understand that there are no credits for missed days and I understand the cancellation policy (See Terms and Conditions)
Rates include: care from 8:00 am to 5:30 pm, breakfast, lunch, snacks and most fieldtrips.
ADDITIONAL FIELD TRIP FEES WILL BE STATED ON THE PARENT LETTER AND COLLECTED THE WEEK OF YOUR CHILD’S ATTENDANCE.
There is an additional $5 fee for every additional 15 minutes that a parent is late to pick up their child. This fee must be paid upon picking the child up.
Applicants that wish to attend only two or three days a week cannot start the week on Wednesday.
Non-Member Total for 1st Child
Price:
$0.00
Member Total for 1st Child
Price:
$0.00
PARENT CONSENT
Name
*
Relationship with child
*
Mother
Father
Guardian
Child's name
*
*
Agrees and authorize to the following
Tylenol Consent:
*
Yes
No
Field Trips & In-House Educational Programs
I authorize my child to participate in any field trips & in-house educational programs organized by Homenetmen Glendale "Ararat" Chapter.
*
Yes
No
Water Play
I authorize my child to participate in supervised water play activities.
*
Yes
No
Photographs & Videos
I authorize Ararat to photograph and video tape my child during his/her camp activities and release these photos and videos to public broadcasting networks or any educational organization for Summer Day Camp introduction purposes.
*
yes
No
Date
*
MM slash DD slash YYYY
I hereby authorize my child to be picked-up from Summer Day Camp Activities in my absence by:
Name
Relationship to Child
Name
Relationship to Child
Name
Relationship to Child
CONSENT FOR MEDICAL TREATMENT
As the parent/legal guardian, I hereby give consent to HOMENETMEN GLENDALE "ARARAT" CHAPTER to seek all emergency dental or medical care prescribed by duly licensed physician (M.D.) or dentist (D.D.S.) for our child in case of illness or accident when neither parent can be located.
*
(Child’s Name)
This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.
Child has the following medication/food allergies
Second Child Registration
Would you like to register for your second child?
*
Yes
No
Second Child's Name
*
First
Last
Gender
*
Male
Female
Birth Date
*
MM slash DD slash YYYY
Grade in August 2017
*
Member of Homenetmen Glendale "Ararat" Chapter
*
Yes
No
Summer Day Camp Second Child
Week 1 - Sold Out
June 11-June 15
Sold Out
Please select which days the child will attend
*
June 11
June 12
June 13
June 14
June 15
Please select which days the child will attend
*
June 11
June 12
June 13
June 14
June 15
Week 2 - Sold Out
June 18-June 22
Sold Out
Please select which days the child will attend
*
June 18
June 19
June 21
June 22
Please select which days the child will attend
*
June 18
June 19
June 21
June 22
Week 3
June 25-June 29
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
June 25
June 26
June 27
June 28
June 29
Please select which days the child will attend
*
June 25
June 26
June 27
June 28
June 29
NO CAMP 4th of July Week: July 2-July 6
Week 4
July 9-July 13
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
July 9
July 10
July 11
July 12
July 13
Please select which days the child will attend
*
July 9
July 10
July 11
July 12
July 13
Week 5
July 16-July 20
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
July 16
July 17
July 18
July 19
July 20
Please select which days the child will attend
*
July 16
July 17
July 18
July 19
July 20
Week 6
July 23-July 27
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
July 23
July 24
July 25
July 26
July 27
Please select which days the child will attend
*
July 23
July 24
July 25
July 26
July 27
Week 7
July 30-August 3
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
July 30
July 31
August 1
August 2
August 3
Please select which days the child will attend
*
July 30
July 31
August 1
August 2
August 3
Week 8
August 6- August 10
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
August 6
August 7
August 8
August 9
August 10
Please select which days the child will attend
*
August 6
August 7
August 8
August 9
August 10
Week 9
August 13-August 17
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
August 13
August 14
August 15
August 16
August 17
Please select which days the child will attend
*
August 13
August 14
August 15
August 16
August 17
PARENT CONSENT
Name
*
Relationship with child
*
Mother
Father
Guardian
Child's name
*
*
Agrees and authorize to the following
Tylenol Consent:
*
Yes
No
Field Trips & In-House Educational Programs
I authorize my child to participate in any field trips & in-house educational programs organized by Homenetmen Glendale "Ararat" Chapter.
*
Yes
No
Water Play
I authorize my child to participate in supervised water play activities.
*
Yes
No
Photographs & Videos
I authorize Ararat to photograph and video tape my child during his/her camp activities and release these photos and videos to public broadcasting networks or any educational organization for Summer Day Camp introduction purposes.
*
yes
No
CONSENT FOR MEDICAL TREATMENT FOR YOUR SECOND CHILD
As the parent/legal guardian, I hereby give consent to HOMENETMEN GLENDALE "ARARAT" CHAPTER to seek all emergency dental or medical care prescribed by duly licensed physician (M.D.) or dentist (D.D.S.) for our child in case of illness or accident when neither parent can be located.
*
(Second Child’s Name)
This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.
Child has the following medication/food allergies
Third Child Registration
Would you like to register for your third child?
*
Yes
No
Third Child's Name
*
First
Last
Gender
*
Male
Female
Birth Date
*
MM slash DD slash YYYY
Grade in August 2017
*
Member of Homenetmen Glendale "Ararat" Chapter
*
Yes
No
Summer Day Camp Third Child
Week 1 - Sold Out
June 11-June 15
Sold Out
Please select which days the child will attend
*
June 11
June 12
June 13
June 14
June 15
Please select which days the child will attend
*
June 11
June 12
June 13
June 14
June 15
Week 2 - Sold Out
June 18-June 22
Sold Out
Please select which days the child will attend
*
June 18
June 19
June 21
June 22
Please select which days the child will attend
*
June 18
June 19
June 21
June 22
Week 3
June 25-June 29
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
June 25
June 26
June 27
June 28
June 29
Please select which days the child will attend
*
June 25
June 26
June 27
June 28
June 29
NO CAMP 4th of July Week: July 2-July 6
Week 4
July 9-July 13
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
July 9
July 10
July 11
July 12
July 13
Please select which days the child will attend
*
July 9
July 10
July 11
July 12
July 13
Week 5
July 16-July 20
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
July 16
July 17
July 18
July 19
July 20
Please select which days the child will attend
*
July 16
July 17
July 18
July 19
July 20
Week 6
July 23-July 27
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
July 23
July 24
July 25
July 26
July 27
Please select which days the child will attend
*
July 23
July 24
July 25
July 26
July 27
Week 7
July 30-August 3
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
July 30
July 31
August 1
August 2
August 3
Please select which days the child will attend
*
July 30
July 31
August 1
August 2
August 3
Week 8
August 6-August 10
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
August 6
August 7
August 8
August 9
August 10
Please select which days the child will attend
*
August 6
August 7
August 8
August 9
August 10
Week 9
August 13-August 17
2 Days ($135)
3 Days ($180)
4-5 Days ($225)
Not Selected
Please select which days the child will attend
*
August 13
August 14
August 15
August 16
August 17
Please select which days the child will attend
*
August 13
August 14
August 15
August 16
August 17
PARENT CONSENT
Name
*
Relationship with child
*
Mother
Father
Guardian
Child's name
*
*
Agrees and authorize to the following
Tylenol Consent:
*
Yes
No
Field Trips & In-House Educational Programs
I authorize my child to participate in any field trips & in-house educational programs organized by Homenetmen Glendale "Ararat" Chapter.
*
Yes
No
Water Play
I authorize my child to participate in supervised water play activities.
*
Yes
No
Photographs & Videos
I authorize Ararat to photograph and video tape my child during his/her camp activities and release these photos and videos to public broadcasting networks or any educational organization for Summer Day Camp introduction purposes.
*
yes
No
CONSENT FOR MEDICAL TREATMENT FOR YOUR THIRD CHILD
As the parent/legal guardian, I hereby give consent to HOMENETMEN GLENDALE "ARARAT" CHAPTER to seek all emergency dental or medical care prescribed by duly licensed physician (M.D.) or dentist (D.D.S.) for our child in case of illness or accident when neither parent can be located.
*
(Third Child’s Name)
This care may be given under whatever conditions are necessary to preserve the life, limb or well being of my dependent.
Child has the following medication/food allergies
Payment Info
Billing Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Credit Card
*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
Expiration Date
Security Code
Cardholder Name
Grand Total
$0.00
Terms & Conditions
*
I agree to the terms and conditions of Ararat Summer Day Camp. (click to view)
As the parent or legal guardian, I have signed and completed a full enrollment form for my child. I certify that all my information is accurate and correct including address, phone numbers, and persons authorized to pick-up my child, etc.
Enter Name (same as your signature)
*
Date
*
MM slash DD slash YYYY
COME HOME TO ARARAT
