Application for 2011 Youth Taking Charge Day Camp,
sponsored by LifeWorks Institute, Inc.
Print this application and send to P.O. Box 96, Wimberley, TX 78676
One application is required per child, per camp, with $50 deposit for each application payable to Youth Taking Charge..
Date of Application ___________,2010 PLEASE PRINT CLEARLY
Name of Child __________________ _______________________, Birth Date__________,
(Last) (First)
Age _______, School Grade in Fall 2010___________
Parent or Guardian Name___________________________________________________________
Relationship to Child ______________________________________________________________
Address _________________________________________________________________________
Work Phone_____________________ Cell Phone______________________________
Email ___________________________________________________________________________
Please check the weeks you wish your child to attend the Youth Taking Charge Day Camp.
______ June 7-June 11 ______ June 14-June 18 ____closed__ June 21-June 25
______ July 12-July 16 ______ July 19-July 23 ______ July 26- July 30
______ August 2-Aug. 6 ______ August 9-Aug. 13 ______ August 16-Aug. 20
Youth Taking Charge Day Camp begins at 8:00am and ends at 5:00pm.
Youth Taking Charge Day Camp is $125/week/child. Early drop off (7-8 am) and late pick up (5-6 pm) is available for an additional fee of $5.00/day/child/drop-off or pick-up.
A deposit of $50/week/child (to be applied to Registration Fee) is due with this Youth Taking Charge Day Camp Application.
Number of weeks for this child __________ Total Deposit $__________
Make checks payable to Youth Taking Charge and send payment in full to P.O. Box 96, Wimberley, TX 78676, or bring May 8thto Youth Taking Charge Open House at 501 Old Kyle Rd., Wimberley, TX
The balance for each week of Youth Taking Charge Day Camp is due upon confirmation that application has been accepted. Send balance to address above.
For additional information call Youth Taking Charege at 512-847-6840 or email admin@youthtakingcharge.us
Youth Taking Charge Open House, May 8th, 2010, at 501 Old Kyle Rd, Wimberley, TX 78676
