Summer Performing Arts Camp 2020
Camp will run June 29th - July 24th
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Student Name *
Grade (2020 - 2021 School year) *
Street Address *
Town *
Home Phone *
Mother/Guardian Name *
Mother/Guardian Cell Phone Number *
Father/Guardian Name *
Father/Guardian Cell phone number *
Parent's Email *
Additional Emergency Contact Number *
Please list Name of Emergency contact
Additional Emergency Contact Number *
Please list Name of Emergency contact
Please list any allergies
Please include Foods, Medications, and Materials
Please list any other health issues your student may have:
Please list any Special Needs or requests your student may have:
Our program may not be able to meet all educational special needs, so please list any below so we can make that determination.  These will be kept COMPLETELY CONFIDENTIAL.  These needs will only be discussed with the director and staff.
Please chooses 5 classes you wish to participate in *
Required
Please choose one 6th Backup class in case other classes are full *
Required
By checking yes you allow us to use your son/daughters image on our website. *
Required
Payments
2020 Camp prices:
Residence (Little Falls, Totowa, Woodland Park) - $325
Non-Residence - $425

Residence Late Fee - $375
Non-Residence Late Fee - $475
(Late registration is anything postmarked or submitted after June 6th)

Any student participating in either Makeup class must pay an extra fee of $15.  This fee includes any supplies needed to purchase by instructors used for the class.

Once this form is submitted, please mail the payment to the following address:

Passaic Valley High School  
CO Mike DeLuccia
100 East Main St
Little Falls, NJ 07424

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