Summer Camp 2011 Registration Form

Website: www.menciusacademy.org Phone: (480)206-3469 Email: www.menciusacademy.org/contact
Hours & Tuition
Full Day: 8:30am – 3:00 pm ($225 per week; $195 for the week of the 4th of July))
Half Day: 8:30am- 12:00 pm ($195 per week)
Extended Hours
Moring: 7:30- 8:30am $8 per hour, or $150 per session (4 weeks)
Afternoon: 3:00 – 5:30pm $8 per hour or $300 per session (4 weeks)
Siblings receive a 10% tuition discount!

Student Information:
Name:___________________________________________________

Date of Birth:_____________ Grade Level:________ School:_________________

Parent Information:
Mother’s Name: _________________ E-Mail:______________________________

Address:________________________________________________________

Home Phone: _____________ Cell Phone: _______________Work Phone: ________________

Father’s Name: ___________________ E-Mail:___________________________

Address:________________________________________________________

Home Phone: _____________ Cell Phone: _______________Work Phone: ________________

Emergency Contact:
Name: ___________________________________________________

Relationship to Child:_______________________________________________

Address:_________________________________________________________

Home Phone: _____________ Cell Phone: _______________Work Phone: ________________

Camp Session (Circle One) I / II Camp Start Date:__________________

Select One: ___Full Day ___Half Day Subtotal: $______________________

Extended Hours: Morning or/and Afternoon Subtotal: $______________________

Total Payment Amount:___________

Please make check payable to: Mencius Chinese Academy
Please mail the check to: 8776 E. Shea Blvd. Suite B3A-538, Scottsdale, AZ 85260-6629