Camp Registration Form


	Camp Registration Form

Fill out all the fields below and hit the "Submit" button. Then mail in payment in full to:

Mad Science of Hawaii
PO Box 235324
Honolulu, HI 96823

Please fill out one form for EACH child. Registration is NOT CONFIRMED until payment has been received.

CAMP REGISTRATION FORM

Camp No:

Camp Location:

Camp Start Date:

Child's Name:

Child's Birthday:

Fall 2009 Grade:

Health Concerns:

Parent/Guardian Name:

Other person/s authorized to pick up child:

Email:

Home Phone#:

Cell Phone#:

Mailing Address:

City/Zip:

Would you be interested in a late pickup/extended care option if made available?      Yes        No

Payment Method

You may choose from two payment methods:

Payment Method Requested:CheckCredit Card

1) CHECK: All payments will be cashed 4 weeks prior to camp start date.

2) CREDIT CARD PAYMENT: Processed no later than 4 weeks prior to camp start date. Card info must be provided below if choosing this option.

Credit Card: Visa   Mastercard

Card #:

Expires:

Name on Card:

Thank you for enrolling in our Mad Science Summer Camp! An email will be sent to you to confirm your registration once payment has been received.