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Summer Cultural Adventure @ The Knox School 2020
541 Long Beach Rd, St James, NY 11780 camp_info@knoxschool.org 631-686-1640
Camper Information
First Name
Last Name
Gender
M
F
Birth Date ex 11/22/09
*
'19-'20 Grade
Pre K
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Tee Shirt Size
*
Youth Sm
Youth Med
Youth Lg
Adult Sm
Adult Med
Adult Lg
Adult XL
Sponsoring Agency
Name of Agency
*
Address
*
City
*
Country of Origin
*
Zip
*
Phone
*
Cell Phone
*
Email Address
*
Chaperone/Contact Info:
Name:
*
Relationship to camper:
*
Home Phone:
*
Cell Phone:
*
Relationship to camper:
*
Home Phone:
*
Cell Phone:
*
Rates per Session
Must be paid in full at time of registration.
For Credit Card:
Please Choose
*
Credit Card
Bank Account
Credit Card Type
*
Visa
MasterCard
Discover
Name on Card
*
Credit Card Number
*
Expiration Date (mm/yy)
*
CVA Code
*
For Bank Account:
Bank Account #:
Routing #:
SPRING into STEM May 16- May 23, 2020
Please Choose
STUDENT $1,900.00
CHAPERONE $900.00
Jr. Cultural Exchange: Ages 9-12 July 12- July 25, 2020
Please choose:
*
Jr. Cultural Exchange Student $4,300.00
Jr. Cultural Exchange Chaperone $2,000.00
Sr. Cultural Exchange: Ages13-17 Jul7 12- July 25, 2020
Please choose:
*
Sr. Cultural Exchange Student $5,800.00
Sr. Cultural Exchange Chaperone $3,000.00
Terms & Conditions
Please sign to acknowledge you have read and agree to the terms and conditions
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