MADD CAMP 2005
Music, Art, Dance & Drama Camp
A Wonderful Day in the Neighborhood!
August 15-19 9 a.m. to 3 p.m. For 1ST through 6TH Graders
Please fill out separate registration forms for each child.
Child’s Name: _________________________________________________
Child’s Birth Date: ____________ Grade entering Fall 2005: _______
Address: _________________________________
_________________________________ Phone: ______________
Parent/Guardian’s Name(s): _______________________________________
Work/Daytime Phone: ___________________________________________
Additional Emergency Contact_____________________________________
T-Shirt Size (Child sizes):_________________
Is there anything else we should know about your child to help the week run more smoothly? Does your child have any special needs? _______________
_____________________________________________________________
_____________________________________________________________
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_____ $75 advance payment required
_____ $3 per hour for extended care*
_____ Total I will paying for this child
*Please indicate which days and how many hours you will require extended childcare for your child. Extended childcare hours: 8-9 am and 3-6 pm.
Monday_______________ Thursday__________________
Tuesday______________ Friday ____________________
Wednesday____________ Total extended hours: ________
Will your child be able to participate in the Friday evening performance? ______
Checks are made payable to :
Community Church of Sebastopol
P.O. Box 579
Sebastopol, CA 95472
Attention All MADD Campers!
This promises to be a week of fun for all MADD Campers ending with a fabulous concert on Friday evening! Parents, family and friends are invited to attend this special performance.
Lunches are not provided. Please send a bag lunch each day with your child.
Please Note:
¨ Camp will be from 9 a.m. to 3 p.m.
¨ Pre-arranged extended childcare hours are from 8-9 am and 3-6 pm.
¨ All extended childcare hours must be paid in advance with your registration.
¨ Medical releases are mandatory for every camper. They must be filled out and signed prior to the first day of camp.
¨ Each child must be signed in and out of MADD Camp each day by a parent or guardian. No drop offs.
¨ We need to know if your child will be at the performance on Friday. Please include this information with your camp registration. It makes planning the performance so much easier.
Send registration forms, medical release and all payments to:
The Community Church, UCC
P O Box 579
Sebastopol CA 95473
Please call 823-2484 with any questions.
Registration Deadline is August 11, 2005.