Summerstage Mini Registration

Willows SummerStage Mini 2008
Registration Form

You will be sent an e-mail confirmation of your registration.

SESSION: (Session A) June 16 - June 20
(Session B) June 23 - June 27

STUDENT INFORMATION

First Name:

Last Name:

Address:

City:

State:

Zip:

Best Contact Email:

Eve Phone:

Day Phone:

Grade in fall '08:

Age:

School:

How did you hear about the Willows SummerStage camps?

PARENT INFORMATION

First Name:

Last Name:

Address:

City:

State:

Zip:

Email:

Eve Phone:

Day Phone:

Total cost of camp is $125. A deposit of $35 is due with registration. Deposit includes a $15 non-refundable administration fee. Balance must be paid by June 3, 2008. Tuition is non-refundable after June 30, 2008.
Payment Amount:
Type of Credit Card:
Credit Card Number:
Expiration Date:

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