SOC_Dec26_HouseCharge

School's Out Camp: December 26, 2019

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 *

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