Plumb Performing Arts Center

Registration Form

Summer Camp - Ages 3-8 years

Name: ___________________________________________________________

Age:_________________

Address: _________________________________________________________

City/State: _______________________________________________________

Zip: _________________

Phone: _______________________________

Emergency contact: _______________________________________

Phone: _______________________________

Allergies: ________________________________________________________

Weeks attending camp (one week $200.00, two weeks $360.00, three weeks $450.00)

Week 1 _____________

Week 2 _____________

Week 3 _____________

Amount enclosed: $__________________________