2008 Registration Form
Please complete the form below and press "Submit Application".

Note: All fields marked with an * indicates required field
Camper Information
* Family Name * Child's Name * Sex * Date of Birth (mm/dd/yy) * Grade in 9/07 * School Attending * T-Shirts Size
/ /
/ /
/ /
Mailing Information
* Adress1
 Adress2
Apt #
 *Home Phone
* City
*State
 * Zip
 Email
Registration Information
* Registration Length/Session
 * Wich Date Started: 
*Date Beggining:
(mm/dd/yy)
/ /
*Date Ended:
(mm/dd/yy)
/ / 		Date Beggining:
(mm/dd/yy)
/ /
Date Ended:
(mm/dd/yy)
/ /
* How many days per week?
(Pre-School, Adventures & Stars)
Monday Tuesday Wednesday Thursday Friday
Bus Service - If no bus service is needed, please leave this section blank
Pick up and drop off times are determined by the transportation provider based on area and distance from the camp facility and MUST BE AT THE SAME LOCATION. Families enrolled for bus service will be contacted with approximate morning pick up and evening drop off times prior to the start of the camp season. Transportation is door to door wherever possible. If door to door is not available, such as dead end street or where construction is ongoing, another location will be chosen and those families will be notified.
Which days do you need bus service?
Early morning Drop Off & Late Stay Pick Up - If not needed, please leave this section blank
This program does not include bus service
Early A.M. Drop Off
Please check the days that apply
Late P.M. Pick Up
Please check the days that apply
Parent Information
Mother Full Name
* Contact Phone
Cell Phone
Father Full Name
* Contact Phone
Cell Phone
Emergency Contacts - OTHER THAN PARENTS
* Full Name
* Contact Phone
Cell Phone
Full Name
Contact Phone
Cell Phone
Full Name
Contact Phone
Cell Phone
Authorized Pick Ups - OTHER THAN PARENTS
* Full Name
* Contact Phone
Cell Phone
Full Name
Contact Phone
Cell Phone
Full Name
Contact Phone
Cell Phone
Medications / Limitations / Requests / Comments
Will your camper require medications
during camp hours?
 If yes, please explain type and reason
Does your camper have any limitations
while in camp?
 If yes, please explain type

Please place my camper(s) in a group with the following children
(Subject to availability)

General Comments

Please tell us how your heard about Manhattan Beach Cool Kids Camp
(Check all that apply)

Returning Customer Brooklyn Parent Magazine
Russian Parent From Internet

Other

I will be paying by

cash check Credit Card (you will be contacted for card information) other
It other Checked Please explain:  
I would like to receive my camp supplies by:

Picking them up at MBDC

By Mail at the address I Entered.

Contract Agreement
I understand that my full payment is due by June 1, 2008. Failure to pay the full balance by stated date will result in the automatic cancellation of enrollment and forfeiture of all fees paid to date. NO REFUNDS WILL BE ISSUED AFTER JULY 02, 2008. CAMPER WILL NOT BE OFFICIALLY REGISTERED UNTIL ALL BALANCES ARE PAID IN FULL BY ABOVE DATE. Manhattan Beach Cool Kids Camp reserves the right to suspend and/or expel any camper. Refunds, if any are at the sole discretion of Manhattan Beach Cool Kids Camp. I agree to allow my child to participate in all programs and trips and allow the use of any photographs or video for future publication materials unless otherwise specified. I understand that by signing this agreement I authorize Manhattan Beach Cool Kids Camp to make all necessary emergency decisions, including medical treatment, when I or the persons I have listed under “Emergency Contacts” cannot be contacted.

I have read and understand both the parent legal agreement and contract aggreement. :
Initialize Here    (doing so accepts above agreement)

Copyright 2007 , All right Reserved.