Registration for POTS BACK-2-SCHOOL Summer Camp 2021 for children entering K and 1st grade

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For details and fees check us out all of our summer programs at https://www.potsot.com/summer-programs

Please fill out one form per child

Email *

Parent's Name *

Parent's Cellphone *

Emergency contact *

Child's Name *

Child's Date of Birth *

YYYY

What grade is your child going into? *

Is your child currently receiving services at POTS *

Yes

Please register my child for the following dates *

Full 2-WEEK INTENSIVE BACK-TO-SCHOOL CAMP 8/23-9/2 FEE $999.00

*Week 1, only: August 23 - August 26 FEE $549.00

*Week 2, only: August 30 - September 2 FEE $549.00

Please check to indicate your agreement with our policies *

A non-refundable deposit of $100.00 is due upon registration to hold your spot

Full payment for the program is due 7 days before the start of the program

There are no refunds

Groups are subject to cancellation based upon enrollment

Make-ups are not available for missed/absent group sessions

I will email info@potsot.com or call 201-837-9993 to provide my billing Information

If I have not been a client of POTS within the past 12 months I will bring my child for an informal meeting prior to camp.

I have read and accepted the above terms

Required

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