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COVIDWAIVER
School's Out Camp: April 8, 2020
HOUSE CHARGE REGISTRATION FORM
If current PEAC Members would like to register their child for SOC and have their house account charged please fill out this form.
*
Indicates required field
PEAC Member Name
*
First
Last
Phone
*
Email
*
Time of day your child/ren attend (please check all that apply)
*
Full Day (9am-4pm)
Half Day (9am-12pm)
Before Care (8-9am)
After Care (4-6pm)
CHILD 1 Name & Date of Birth
*
CHILD 2 NAME & Date of Birth
*
CHILD 3 Name & Date of Birth
*
Child 4 Name & Date of Birth
*
Emergency Contact Name
*
In case parent cannot be reached.
EMERGENCY CONTACT NUMBER
*
MEMBER: Full Day $65, Half Day $45, Siblings $20
FAMILY PLAN: Full Day $45, Half Day $20, Siblings $10
BEFORE CARE: $5/child
AFTER CARE: $10/child
Total Cost
*
By submitting this form I authorize PEAC to charge the TOTAL COST to the account I have on file.
Submit
Classes
schedule
descriptions
Programs
Personal Training
Performance Training
Fitness
Massage
Seniors
adult art
Events
Sports
Kids
KidSpace
Parties
COVIDWAIVER