EmailMeForm
New Haven CT - Weekly Pay 2025
Immanuel Church
Week Selection
*
Please select
Wk 1: Mon June 23 – Fri June 27
Wk 2 Mon June 30 - Thurs July 3rd (No Fri July 4th - Independance day)
Wk 3: Mon July 7 – Fri July 11
Wk 4: Mon July 14 – Fri July 18
Wk 5: Mon July 21 - Fri July 25
Wk 6: Mon July 28 - Fri Aug 1
Wk 7: Mon Aug 4 - Fri Aug 8
Wk 8: Mon Aug 11 - Fri Aug 15
Wk 9: Mon Aug 18 - Fri Aug 22
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)
Child #1: Camp Week Duration
Please select
1 Child: Any 3 weeks (includes Discounts)
---------
1 Child: Full Day / 1 Week (8:00am-6:00pm)
1 Child: Morning Half Day / 1 Week (8:00am-12:30pm)
1 Child: Afternoon Half Day/ 1 Week (12:30pm-6:00pm)
1 Child: Only 1 Day in the Week
1 Child: 2 Days
1 Child: 3 Days
----------------
1 Child: All 9 weeks (includes Discount)
Child #2 Name
First
Last
2 Children: 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: Any 3 weeks (includes Discounts)
--------
2 Children: Full Day / 1 Week (8:00am-6:00pm)
2 Children: Morning Half Day / 1 Week (8:00am-12:30pm)
2 Children: Afternoon Half Day/ 1 Week (12:30pm-6:00pm)
2 Children: Only 1 Day in the Week
2 Children: 2 Days
2 Children: 3 Days
-----------
2 Children: All 9 weeks (includes Discount)
Child #3 Name
First
Last
3 Children: 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: Any 3 weeks (includes Discounts)
---------------
3 Children: Full Day / 1 Week (8:00am-6:00pm)
3 Children: Morning Half Day / 1 Week (8:00am-12:30pm)
3 Children: Afternoon Half Day/ 1 Week (12:30pm-6:00pm)
3 Children: Only 1 Day in the Week
3 Children: 2 Days
3 Children: 3 Days
------------
3 Children: All 9 weeks (includes Discount)
What Day (s) will you be attending?
Monday
Tuesday
Wednesday
Thursday
Friday
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)
Do you Need an additional ALM Shirt?
*
Yes - I want an additional ALM Shirt($10)
No - I do not need an additional ALM Shirt ($0)
Total
$2.25
