Ohio Wushu Academy 2015 Summer Camp Registration Form.pdf

Camper’s Name Gender Age Present Grade in School
Parent’s Name Home Phone ()
Address
Street or box number
City
State Zip
E-mail Cell Phone ()
Emergency Contact Information:
Name Phone () Relationship
Please Select Camp Options:
$225/week, full day (8:30a-5:30p) Week of 6/15-6/19
$225/week, full day (8:30a-5:30p) Week of 6/22-6/26
$225/week, full day (8:30a-5:30p) Week of 7/13-7/17
$225/week, full day (8:30a-5:30p) Week of 7/20-7/24
$225/week, full day (8:30a-5:30p) Week of 8/3—8/7
$125/week, half day; please select am or pm: 8:30a-12p Week of 6/15-6/19
$125/week, half day; please select am or pm: 8:30a-12p Week of 6/22-6/26
$125/week, half day; please select am or pm: 8:30a-12p Week of 7/13-7/17
$125/week, half day; please select am or pm: 8:30a-12p Week of 7/20-7/24
$125/week, half day; please select am or pm: 8:30a-12p Week of 8/3—8/7
$65/day, single day (8:30a-5:30p), please circle the days
6/15 6/16 6/17 6/18 6/19 6/22 6/23 6/24 6/25 6/26 7/13 7/14 7/15 7/16
7/17 7/20 7/21 7/22 7/23 7/24 8/3 8/4 8/5 8/6 8/7
Parent’s signature
Registration Deadline: 6/8/15. $50 due at the time of registration, remaining balance due on the first day of camp.
Make checks payable to: OH Wushu Academy or Sen Gao
Ways to Register: Completed registration forms can be turned in 1) in person/on site 2) emailed to [email protected] , or 3) send a picture of the completed form to Master Gao through Wechat
For Office Use Only: Payment Received on
6755 Dublin Center Dr, Dublin, OH 43017 (inside Dublin AMC shopping center)
Phone: (773) 667-6850; Email: [email protected]
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