Children Age 4 to 13 by June 17th, 2019

Playgrounds start Monday, June 17th and ends Thursday, August 8th!

Child's First Name: * Child's Last Name: * Phone Number: * Age as of June 15th, 2019: * Parent/Guardian Name: * E-mail: * Allergies: T-shirt(Optional)-- Additional ($8 USD) Special Requests?(Letters only) *

Park Options: * Stuart McBride Park Ages 4-8: AM Session 8:45am-11:30am Drozd Park Ages 4-8: AM Session 8:45am-11:30am Drozd Park Ages 8-13: PM Session 12:45pm-3:30pm Smolenski Park Ages 8-13: AM Session 8:45am-11:30am Smolenski Park Ages 4-8: PM Session 12:45pm-3:30pm

Address:(Please include city and zip code) *

Fees: No refunds. Sales tax included if applicable * Resident of Mt. Pleasant: $75 + $2.50 Electronic Transaction Fee= ($77.50 USD) Non-Resident of Mt. Pleasant: $95 + $2.50 Electronic Transaction Fee= ($97.50 USD)

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Parent or Guardian Signature: *

Date: Tuesday, 23 April 2019 (EDT)

Name:

Type your name to sign this document:

Typing name is equivalent to a handwritten signature

Notice: Parents will be contacted a week before start date with details for the summer.

* indicates required fields