Summer Day Camp Enrollment Childs Name: Gender:SelectBoyGirl Birthday (xx/xx/xxxx): USCF Rating: Parent Name (first and last): Home Phone: Mobile Phone: E-mail: Address: City: State: Zip: Fee Schedule: (if you are attending the afternoon portion of camp hosted by Mission Bay Montessori Academy you must follow this link to select your activity and to enroll.) $139.00 - Due with Enrollment Chess Camp times are 9am - 12pm Select Camp Dates: June 26 - June 30 July 3 - July 7 July 10 - July 14 July 17 - July 21 July 24 - July 28 July 31 - August 4 August 7 - August 11 August 14 - August 18 Purchase a T-Shirt (T-Shirts will be waiting for you at the camp, price is included in the deposit) Size of First T-Shirt (additional $18):SelectSmallMediumLargeX LargeXX Large Size of Second T-Shirt (additional $18):SelectSmallMediumLargeX LargeXX Large Payment Method: SelectVisaMastercardDiscover Credit card number: Exp (mm/yy): Three Digit Code on the Signature Panel on the back of the card: NAME (as it appears on credit card): I approve this application and certify the applicant(s) capable of such an experience. I grant permission for the applicant to participate in all camp activities understanding that competent leadership will be provided. In case of accident the camp is authorized to secure emergency medical treatment. The camp is not responsible for lost, stolen or damaged personal articles. I authorize the camp to have and use photographs, slides and video tapes of the person(s) names on this application.