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Summer Day Camp Registration
admin
2023-01-06T15:40:12-05:00
Summer Day Camp Registration
Back to Summer Information
Camp Authorization Form
Info for Registered Campers
Bullis School Extended Day Registration
The county requires parents of all campers to fill out:
A
Camp Authorization Form
2023 Summer Day Camp Registration Form
(9am - 12pm, 12pm - 3pm, 9am - 3pm)
Camper's Name
*
First
Last
Age
*
Please enter a number from
5
to
15
.
Players age 5 - 6 may only register for Morning Half Day Camps.
Parent Information
Parent's Name
*
First
Last
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Parent's Email Address
*
Enter Email
Confirm Email
Home Phone
*
Parents's Mobile Phone
Parent's Office Phone
Camp Options & Fees
3 Registration Options:
1) Multi-Week Discount Packages
2) Individual Weeks
3) Drop In Full or Half Days
Multi-Week Discount Packages
Package Selection
4 Weeks of Morning Half Day (9am - 12) $1,200
4 Weeks of Afternoon Half Day (12 - 3pm) $1,200
4 Weeks of Full Day (9am - 3pm) $1,940
8 Weeks of Morning Half Day (9am - 12) $2,240
8 Weeks of Afternoon Half Day (12 - 3pm) $2,240
8 Weeks of Full Day (9am - 3pm) $3,680
Nothing/Clear
Select Desired Package Weeks (4 or 8)
Week 0p: June 12 - 16
Week 1p: June 20 – 23 (4 days)
Week 2p: June 26 - 30
Week 3p: July 5 - 7 (3 days)
Week 4p: July 10 - 14
Week 5p: July 17 - 21
Week 6p: July 24 - 28
Week 7p: July 31 - Aug 4
Week 8p: Aug 7 - 11
Week 9p: Aug 14 - 18
Additional weeks can be purchased at the discounted rate via emailing admin@passacademybullis.com
Individual Weeks
Week 0n: June 12 – 16
Morning Half Day (9am-12 - Wk0) $330
Afternoon Half Day (12-3pm - Wk0) $330
Full Day (9am-3pm - Wk0) $540
Nothing/Clear
Week 1n: June 20 – 23 (4 days)
Morning Half Day (9am-12 - Wk1) $270
Afternoon Half Day (12-3pm - Wk1) $270
Full Day (9am-3pm - Wk1) $440
Nothing/Clear
Week 2n: June 26 – 30
Morning Half Day (9am-12 - Wk2) $330
Afternoon Half Day (12-3pm - Wk2) $330
Full Day (9am-3pm - Wk2) $540
Nothing/Clear
Week 3n: July 5 - 7 (3 days)
Morning Half Day (9am-12 - Wk3) $200
Afternoon Half Day (12-3pm - Wk3) $200
Full Day (9am-3pm - Wk3) $330
Nothing/Clear
Week 4n: July 10 - 14
Morning Half Day (9am-12 - Wk4) $330
Afternoon Half Day (12-3pm - Wk4) $330
Full Day (9am-3pm - Wk4) $540
Nothing/Clear
Week 5n: July 17 - 21
Morning Half Day (9am-12 - Wk5) $330
Afternoon Half Day (12-3pm - Wk5) $330
Full Day (9am-3pm - Wk5) $540
Nothing/Clear
Week 6n: July 24 – 28
Morning Half Day (9am-12 - Wk6) $330
Afternoon Half Day (12-3pm - Wk6) $330
Full Day (9am-3pm - Wk6) $540
Nothing/Clear
Week 7n: July 31 - Aug 4
Morning Half Day (9am-12 - Wk7) $330
Afternoon Half Day (12-3pm - Wk7) $330
Full Day (9am-3pm - Wk7) $540
Nothing/Clear
Week 8n: Aug 7 - 11
Morning Half Day (9am-12 - Wk8) $330
Afternoon Half Day (12-3pm - Wk8) $330
Full Day (9am-3pm - Wk8) $540
Nothing/Clear
Week 9n: Aug 14 - 18
Morning Half Day (9am-12 - Wk9) $330
Afternoon Half Day (12-3pm - Wk9) $330
Full Day (9am-3pm - Wk9) $540
Nothing/Clear
Drop In Full or Half Days
Number of Drop In Half Days ($80 per day)
Quantity
Price:
$80.00
Quantity
9am-12 or 12-3pm
Drop in Half Day Choice
Morning Day Camp (9am-12)
Afternoon Day Camp (12-3pm)
Nothing/Clear
Drop In Half Day Date(s)
Enter desired date(s).
Number of Drop In Full Days ($130 per day)
Quantity
Price:
$130.00
Quantity
9am-3pm
Drop In Full Day Date(s)
Enter the desired Day Camp date(s).
Total Fees
$0.00
Credit Card
*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
Expiration Date
Security Code
Cardholder Name
Session
Summer: June 12th - August 18th 2023
Medical Authorization & Release
Camper Name
*
First
Last
Camper Condition
*
By checking this box it is understood that the student is in overall good physical health. If your child has a physical condition that may limit or restrict participation in certain activities, a physician’s note granting permission to participate in such activities must be presented prior to the first camp session.
Date of Medical Authorization
*
MM slash DD slash YYYY
By dating above, in an emergency, when I/we cannot be contacted, I/we hereby authorize the staff of the Pass Academy to take my/our child to the emergency room of the nearest hospital. I/we authorize that hospital and its medical staff to provide treatment deemed necessary for the well-being of my/our child.
Date of Parent Release
*
MM slash DD slash YYYY
By dating above, I agree to hold Pass Academy and Bullis School harmless for injury or loss that may occur as a result of my participation in Pass Academy activities.
Cancellation Policy
*
By checking this box I accept the following policy. All refunds prior to the start of the program are subject to fee charges of 6%. No refunds after the start of the program.
Permission for Photo Use
*
Yes
No
I give permission for photos of my child participating in Pass Academy at Bullis programs to be taken and used for the Website and/or Facebook page. We understand that if students are identified, only their first names will be used.
Additional Information (optional)
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