Child's Name: ______________________________________
Age (as of (9/10): _____________ Grade Level (as of (9/10): _____________
Parent/Guardian Name: ______________________________________
Day Time Phone: ______________________________________
Street Address: ______________________________________
Town/State/Zip: ______________________________________
Cell Phone: ______________________________________
Email Address: ______________________________________
Session 1 July 12 - 16, 2010	5th - 6th grades	$275.00
Session 2 July 19 - 23, 2010	7th - 8th grades	$275.00
Session 3 July 26 - 29, 2010	3rd - 4th grades	$220.00
Session 4 August 2 - 6, 2010	5th - 6th grades	$275.00
Session 5 August 9 - August 13, 2010	7th - 8th grades	$275.00
Session 6 August 16 - August 19, 2010	3rd - 4th grades	$220.00
Amount Enclosed $ _______________________________ (Make checks payable to NJMSC/NJSG)
Camp Code:
For camp code, call 732-872-1300 x 20 * PLEASE NOTE: NO registration forms will be accepted without prior phone reservation and special camp code. Driving directions and camp guidelines will be sent prior to the beginning of your child's scheduled camp session.
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