Bella Vista Summer Camp
Child's Name
*
Age (ages 4-14)
*
Grade
*
Home Number
*
Parent or Guardian
*
School Attending
Health Issues
Special Needs
Areas of Computer Interest
Parents Authorization
*
Permission to photograph child
*
No
Yes
How did you hear about the Program?
FOR MORE INFORMATION CALL: 713-692-3944 Mon - Fri 9am -3pm * Closed July 4th
Names of Additional Children
Child Areas of Other Interest
*
Music
Singing
Instrument
Lyrics
Art
Drawing
Painting
Jewelry/Woodwork
Sports
Football
Basketball
Soccer
Tennis
Volleyball
Other
Additional Children
*
1st Child - Base Price
2nd Child (Add $30.00)
3rd Child (Add $60.00)
4th Child (Add $90.00)
5th Child (Add $110.00)
Your Email Address
*
Base Price
$
Modifications
$
Total
$
Online Giving
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