Enrollment Application

Please note: This form is for those interested in possibly enrolling a child in the Purchase Day Camp as a CAMPER. If you are interested in receiving an EMPLOYMENT application, please click here.

Please fill out the form below to request an enrollment application for Purchase Day Camp:

Parent First Name: Parent Last Name:

Street Address:

City: State: Zip:

Home Phone: Parent Email:

Number of Applications Requested:

First Child (first name, gender, fall 2018 grade):

Second Child (first name, gender, fall 2018 grade):

Third Child (first name, gender, fall 2018 grade):

Fourth Child (first name, gender fall 2018 grade):

Comments:

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