YogaKids Summer Camp 2010

Oak Park Yoga 327 Chicago Ave. Oak Park, IL 60302

Registration Form

Student’s Name _____________________________

Entering Grade (2010-11 school year, open to 1^st through 5^th graders)_______

Parent’s Name___________________________

Date and Amount of Payment __________________

(6 classes - $168, additional classes @ $27, 12 classes - $312, additional classes @$25, all 18 classes - $432)

Payment Type: Check or cash receipt Number_________________

                         Charge Card:  MC ___  Visa___

#__________________ 3 digit security code___ exp. date____ zip code____

  (Above numers only needed if charge is not processed in person)

E-mail address  _______________________________

Emergency phone number ________________________________

Special concerns or requests

 

1^st – 5th Grade CAMP DATES (check chosen dates)

Week  Month  Tues    Wed    Thurs              Week  Month  Tues    Wed    Thurs

#1      June     22___  23___   24___               #4     July    13___   14___   15___

#2   June/July 29 ___ 30___   1___                #5    20___   21___   22___

#3            6 ___   7___     8___               #6                27___   28___   29___