Purchase Day Camp 2018 Enrollment Application

Fill out the application below and click "Recalculate Total" at the bottom of the form to continue.


Camper's Last: First: Birthdate: Age (on 7/1/18):

Street: City: State: Zip: Home Phone: ()-

Gender: Grade 2017-18: School 2017-18: Grade 2018-19: School 2018-19:

Special Placement Requests: Camper/Friend: Grade Level (if different from above):

Allergies, Medical Conditions, or Special Needs if any?

Choose your program and number of weeks!
(Camp runs for 8 weeks from Monday June 25th to Friday August 17th)
 
Full Day
Mini Day
Half Day
Hours
9am - 4pm
9am - 1:45pm & 2pm
9am - 12:10pm
Camper Eligibility
All Campers Eligible
Entering Kindergarten & Younger
Pre-K Only - 3 by September 1st
Fee includes Lunch PLUS
Bus* or Extended Hours,
Towel Service, Camp Bag & Shirt
Fee includes Lunch PLUS
AM Bus* or AM Extended Hours
,
Towel Service, Camp Bag & Shirt
Fee includes AM Bus* or
AM Extended Hours,
Towel Service, Camp Bag & Shirt
8 Weeks
$6250
7 Weeks
6 Weeks
5 Weeks
4 Weeks
3 Weeks
2 Weeks
Choose Which Weeks You Want - Check Each Week Requested

June 25 - 29


July 2 - 6

(Closed July 4th)


July 9 - 13



July 16 - 20



July 23 - 27



July 30 - August 3


August 6- 10



August 13 - 17

Customize Your Options!

Bus or
Extended Hours
Service Options
*Please see transportation areas here.
Deductions apply for:
AM Service
or
PM Service
or
Both

Full Day
Mini Day
Half Day
AM Service (Choose One)
Deduct $250 for No AM Service
AM Service (Choose One)
Deduct $250 for No AM Service
AM Service (Choose One)
Deduct $250 for No AM Service
PM Service(Choose One)
Deduct $250 for No PM Service
Mid-Day Service
Available in Purchase, West Harrison and Rye Brook Only
PM Service
Not Available
Lunch
(Included for Full and Mini)
Lunch Plan Declined
Lunch Plan Declined
Lunch is not part of the
Half Day Program
Discounts - Check All That Apply
Sibling After First Child
2017-18 After School
Full Year Member
Camper entering 9th Grade
Camper entering 10th Grade

Mother or Guardian Contact Information:



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Father or Guardian Contact Information:



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Total: $7950

A $1000 deposit is required with this application.




3095 Purchase Street • Purchase, NY 10577 • Tel. 914-949-2636 • Fax. 914-949-0955
office@purchasehouse.com