ENROLLMENT FORM
 
I would like to enroll my child in the:
 
W.I.N.TM____   Summer Sensory Program___  P.O.P.TM___  P.O.P.TM for 3-year-olds___
 Pricing:
 W.I.NTM - $625 Summer Sensory - $600  P.O.P.TM - $575 P.O.P.TM for 3-year-olds - $255

Please use a separate form for each camp

DATES_____________________________________________________________________________________

Program and Location_________________________________________________________________________

Child's Name________________________________________________________________________________

Age________ Grade________

School_____________________________________________________________________________________

Parent(s) Name(s)____________________________________________________________________________

Address____________________________________________________________________________________

Telephones__________________________________________________________________________________

Emergency Telephone (non-parent)______________________________________________________________

Method of payment: check (preferred)_______ or charge________

Checks payable to: Children's Special Services, LLC

If paying by check

Check number________________________________________________________________

If paying by charge, note that only Visa and Mastercard are accepted and an additional 4% processing fee will apply

Visa_______ Mastercard_______

Charge Card Number___________________________________________ Expiration Date___________________

Signature_____________________________________________________________________________________

Mail form to:

Children's Special Services, LLC

7501 Auden Trail

Atlanta, GA 30350