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

Birth Date ex 11/22/09 *

'19-'20 Grade

Tee Shirt Size *

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 *

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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