Hotshots Registration Form Step 1 of 4 25% Camper First Name*Camper Last Name*Grade going into Sept. 2019*Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th GradeOpen to boys and girls entering Pre-K - 3rd grade and boys 4th - 8th grade.School attending* Parent InfoParent First Name*Parent Last Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home PhoneCell Phone*2nd Cell PhoneEmail* 2nd Email Emergency ContactEmergency Contact Full Name*Emergency Contact Home PhoneEmergency Contact Cell Phone*Emergency Contact Email Sessions SelectionsWeekly Pricing: 1 Week Session – $375 Multiple week discount – 2 weeks $350 per weekCamp Sessions* Monday June 24, 2019 - Friday, June 28, 2019 @ Yavneh Academy Monday August 19, 2019 - Friday, August 24, 2019 @BPY Subtotal for weeks selectedAre you planning on being part of a group or attending with a sibling?* No Attending with a Sibling | $10 off per week Yes (5+ Campers | 5% Off) Yes (10+ Campers | 10% Off) Coupon Total for one week Price: $375.00 Total for two weeks Price: $700.00 Total for three weeks Price: $975.00 Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name We will be in touch with you shortly to coordinate a Group and/or Sibling discount. Please press "Submit" to complete your registration form.NameThis field is for validation purposes and should be left unchanged.
