Sign me up for POTS Back-to-School Camp

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3-Week Intensive Fun Summer Camp

DATES: Join 1, 2 or all 3 week sessions August 15, August 22 and August 29 . Monday-Thursday
TIMES: 9:00-12:30

FEES:
1 week: $400.00
2 weeks $800.00
3 weeks $1200.000

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

How many weeks are you signing up your child for? *

1 week: $400.00

2 weeks $800.00

3 weeks $1200.000

Required

Which weeks would you like to sign up for? *

Week 1 - 8/15-8/18

Week 2 - 8/22-8/25

Week 3 - 8/29-9/1

Required

Is your child currently receiving services at POTS *

Yes

What are your goals for your child? *

Please check to indicate your agreement with our policies *

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

Tuition is non-refundable

Sessions are not billed to insurance

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

I have read and accepted the above terms

Other:

Required

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