* Student Name(s): * Age(s):

* Primary Phone:  Secondary Phone:

* Email Address:

* Mailing Address:

* Class:

(By typing my full name below, I hereby consent for my child to attend Monart summer camp)

*

* (check one):  PAYMENT MUST BE ARRANGED IN ORDER TO SECURE A SPOT

pay by check  (make checks payable to "Monart")

pay by credit card  (fill out card info below  or  call in your card with the office)

       Name: (as it appears on card)

       Card #  Exp.  Total $

       Comments:

* Required Fields