12/16/2017
(240)-453-9790
(301)-801-2100

Summer Camp
Registration for Summer 2017

Parent's First Name*:
Parent's Last Name*:
Street Address*:
City*:
State*:
Zip*:
Home Phone*:
Cell Phone:
e-Mail Address*:
Work Phone:
Child's First Name*:
Child's Last Name*:
Age*: School Grade*:

Summer Camp 2017
Attendance Schedule:












Comments:

The electronic registration is not final and does not guarantee your child's enrollment. To finalize enrollment a deposit covering the cost of the last week of attendance is required. Please send all required documents and a deposit check made payable to Vladimir Gurevich to:
13544 Glen Mill Rd, Rockville MD 20850