Participant Information

* Child's First Name

* Child's Last Name

* Birth Date

* Thacher Student

Adult Contact

* Parent/Guardian First Name

* Parent/Guardian Last Name

* Address 1

Address 2

* City

* State

* Zip

* Phone

Alternate Phone

* Email Address

Emergency Contacts

* Name:

* Relationship:

* Phone

Name:

Relationship:

Phone

2012 Elementary/Adolescent Summer Program - Register below if you want to pay 50% deposit. Balance is due June 1.

Elementary/Adolescent Summer Programs 50% will be subtracted from prices listed below. Please remember to pay balance by check before June 1, 2012.

2012 Elementary/Adolescent Summer Program - Register below if you want to pay in full.

Elementary/Adolescent Summer Programs

Orders are processed throughPayPal. Once you complete this form you will automatically be forwarded to the secure PayPal site.

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