EmailMeForm
Pines/Miramar FL (combined) Weekly Quick Pay 2022
Location Confirmation
*
Pines/Miramar FL (Tanglewood / Jus Hip hop / Miami Gdns)
Week Selection
*
Please select
Week 1 - Mon June 13 - Fri June 17
Week 2 - Mon June 20 - Fri June 24
Week 3 - Mon June 27 - Fri July 1
Week 4 - Tue July 5 - Fri July 8
Week 5 - Mon July 11 - Fri July 15
Week 6- Mon July 18 - Fri July 22
Week 7 - Mon July 25- Fri July 29
Week 8 - Mon Aug 1 - Fri Aug 5
Week 9 - Mon Aug 8 - Fri Aug 12
How Many Children are Attending?
*
Please select
1 Child
2 Children
3 Children
Child #1 Name
First
Last
Child #1: Registration Status
Please select
First Time - Need to Pay Reg Fee ($50)
Already Paid Reg Fee ($0)
1 Child: Camp Week Duration
Please select
1 Child: Full Day (7:30am-6:00pm)___Miramar
1 Child: Morning Half Day (7:30am-12:30pm)___Miramar
1 Child: Afternoon Half Day (1:00pm-6:00pm)___Miramar
1 Child: Only 1 Day in the Week___Miramar
1 Child: 2 Days___Miramar
1 Child: 3 Days___Miramar
Child #2 Name
First
Last
Child #2: Registration Status
Please select
First Time - Need to Pay Reg Fee ($100)
Already Paid Reg Fee ($0)
2 Children: Camp Week Duration
Please select
2 Children: Full Day (7:30am-6:00pm)___Miramar
2 Children: Morning Half Day (7:30am-12:30pm)___Miramar
2 Children: Afternoon Half Day (1:00pm-6:00pm)___Miramar
2 Children: Only 1 Day in the Week___Miramar
2 Children: 2 Days__Miramar
2 Children: 3 Days___Miramar
Child #3 Name
First
Last
Child #3: Registration Status
Please select
First Time - Need to Pay Reg Fee ($100)
Already Paid Reg Fee ($0)
3 Children: Camp Week Duration
Please select
3 Children: Full Day (7:30am-6:00pm)___Miramar
3 Children: Morning Half Day (7:30am-12:30pm)___Miramar
3 Children: Afternoon Half Day (1:00pm-6:00pm)___Miramar
3 Children: Only 1 Day in the Week___Miramar
3 Children: 2 Days___Miramar
3 Children: 3 Days___Miramar
Mothers or Fathers Name
*
First
Last
Cell Number
*
###
-
###
-
####
Email
need for payment confirmation
Do you Need ALM as an Primary Insurance for the Week
*
Yes - I want ALM Insurance as Primary ($10 family)
No - Ill use my Own Insurance as Primary ($0)
Total
$2.00
