2013 HAWKS HAVEN REGISTRATION FORM
USE THIS FORM FOR HAWK'S HAVEN DAY CAMP ONLY!
USE ONE FORM PER CHILD. PHOTOCOPY IF NECESSARY.
STUDENT NAME____________________________________________________________________________
AGE________ DATE OF BIRTH_____/_____/_________ MALE FEMALE
ADDRESS________________________________________ CITY/STATE/ZIP___________________________
CURRENT GRADE __________ CURRENT SCHOOL_______________________________________________
SELECT ONE DIVISION/TERM:
NEST
PRIMARY
MIDDLE
4 WKS $850 5 WKS $1000 6 WKS $1150 7 WKS $1300 8 WKS $1450
ADDITIONAL WEEKS CAN BE ADDED AT ANYTIME; PAYMENT DUE AT TIME OF ENROLLMENT!
10% discount for each additional child from the same family can be applied!
Please indicate weeks Camp runs from 9:00 am - 4:00 pm daily
attending: Early and late supervision provided from
June 17-21 7:15 - 9:00 am & 4:00 - 6:00 pm at no
June 24-28 additional cost.
July 1-3 All Hawk's Haven campers must bring
July 8-12 lunch and drink daily!
July 15-19
July 22-26 $250 DEPOSIT MUST ACCOMPANY
July 29- Aug. 2 REGISTRATION!
Aug. 5-9 BALANCE MUST BE PAID BY JUNE 17, 2013!
PARENT INFORMATION - ALL INFORMATION MUST BE COMPLETED
Circle one: Mr. / Mrs. / Dr. / Ms. Circle one: Mr. / Mrs. / Dr. / Ms.
Parent/guardian 1____________________________ Parent/guardian 2_________________________________
Address___________________________________ Address________________________________________
City,State, Zip______________________________ City,State, Zip_____________________________________
Home phone_______________________________ Home phone______________________________________
Work phone_______________Cell______________ Work phone___________________Cell________________
E-mail_____________________________________ E-mail_________________________________________
Name of person(s) authorized to pick-up child______________________________________________________
NON-PRAIRIE STUDENTS MUST PROVIDE COMPLETE, UPDATED IMMUNIZATION RECORDS WITH
REGISTRATION FORM AND PAYMENT!
Enclosed is my payment of $_________($250 min. deposit required) 10% multi-student discount applied
VISA Mastercard (credit card authorization is for initial balance AND any subsequent 2013 enrollment)
Name on card___________________________________ Card #_____________________________________
Exp. date_____________ Signature_____________________________________________________________
A full refund will be allowed if cancellation is requested by June 1, 2013. I authorize this student to participate in Prairie's 2013 HAWK'S
HAVEN DAY CAMP. Prairie Summer Programs reserves the right to refuse enrollment to students who demonstrate disruptive or unsafe
behavior, with no refund. Prairie Summer Programs reserves the right to cancel any camp or program that does not meet minimum
enrollment requirements. I authorize Prairie's Director of Summer Programs or designee to arrange for emergency treatment by
qualified personnel for my child. I understand that photographs of my child may be used in The Prairie School promotional materials.
_____________________________________________________________________________________________________________________
Parent/guardian signature Date
Registrations without Parent/guardian signature will be returned!
Forms should be returned with your
payment (credit card or check made
payable to The Prairie School)
Send to:
Director of Summer Programs
The Prairie School
4050 Lighthouse Dr.
Racine, WI 53402
Confirmation will be sent once
registration and payment are
received.
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