2011 Winter FIT AND FUN CAMP APPLICATION FORM
Please print and mail this form to 112 Buchanan Dr. York, Pa 17402 or bring it with you to the Tiny Tumblers gym.

Child's name:
__________________________________________________________

Street address:
__________________________________________________________

City and ZIP code:
__________________________________________________________

Phone number & Confirmation Email:
__________________________________________________________

Emergency phone number:
__________________________________________________________

Child's birthdate and gender:
__________________________________________________________

Any medical conditions we should be aware of?
__________________________________________________________

Food allergies:
__________________________________________________________

Parent's signature:
__________________________________________________________

Parent's name (please print):
__________________________________________________________

CAMP SESSION----Deposit Paid($20 per child)______________

Balance Due 1st Day of Camp_______________

Cost-$50 for 2day with a $5 sibling discount per sibling.

(Please circle weeks your child will be attending)
June 14-16     June 21-23     June 28-30      July 5-7      July 12-14

July 19-21     July 26-28     Aug. 2-4      Aug. 9-11