POTOMAC VALLEY SPORTS CAMP
CAMP REGISTRATION FORM 2010

Child’s Name: _______________________________

Address: _______________________________

City: _______________________________

State: _______________________________

Zip: _______________________________

Grade (Fall 2009)________________________

Day Phone: (      )_______________________________

Evening Phone: (    )_______________________________

Email(s): __________________________

Parent’s or guardian Signature: ___________________________________________

__Session I          June 21 -   July 2

__Session II         July 5    -  July 16

    Session III       July 19 -  July 30

This registration form must be accompanied by a non-refundable deposit of $50.00 per child/per session payable to CESJDS.  The registration is deducted from the cost of the program.  Full payment is due no later than May 15, 2009 or before the beginning of a session for late registrations.

APPLICANTS WILL RECEIVE CONFIRMATION OF ACCEPTANCE, EMERGENCY RELEASE FORMS, AND INFORMATION ON EARLY DROP AND AFTER CAMP PROGRAM.  

Mail to: CESJDS 

Att: JEFF ROSE, Director of Athletics and Summer Programs
11710 Hunters Lane
Rockville, MD 20852

For additional information, call (301) 881-1404, ext. 4990.