Summer Day Camp Registration – Bullis Pass Academy

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Summer Day Camp Registrationadmin2023-01-06T15:40:12-05:00

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 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 19 – 23
- 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 19 – 23
- Morning Half Day (9am-12 - Wk1) $330
- Afternoon Half Day (12-3pm - Wk1) $330
- Full Day (9am-3pm - Wk1) $540
- 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
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
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 Expiration Date Security Code Cardholder Name
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)

Our Contacts

10601 Falls Road
Potomac, MD 20854
director@passacademybullis.com
passacademybullis.com

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