Field Trips Special In-Center Activities Sports & Swimming
Daily Activities For Your School Age Child Ages 6 to 11
You may select a 20, 30 or full-time Summer Program Contract allowing your family greater flexibility
in scheduling your summer activities.
Federal Employee Rates - Payment Schedule Contract Selections – circle one .
20 days 30 days Full Time
Full day program $540.00 $855.00 $1,455.00
First payment - due June 17 180.00 285.00 485.00
Second payment - due July 8 180.00 285.00 485.00
Third payment due - August 5 180.00 285.00 485.00
Activities Fee - per enrolled child
(to be submitted with this application) 90.00 120.00 175.00
Additional days may be purchased at a rate of $30.00 per day.
Feel free to call Carol McConaghy, Center Director, at (717) 228-6091 for more information or complete the form below and return it with the Activities Fee to the child care center. Checks should be made payable to Hildebrandt Learning Centers.
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Child’s Name: ______Child’s Birth Date: ____/____/______
Child’s Nickname: ______Child’s Grade: ______
Parent’s Name: ______
Street Address: ______
City, State, Zip Code: ______
Home Phone: (____) ______Cell Phone: (____) ______Work Phone: (____) ______
Email: ______
Parent’s Signature: ______Date: ______
T-Shirt Size: Small ¨ Medium ¨ Large ¨ Extra Large ¨ (Please check one)
HILDEBRANDT LEARNING CENTERS
Tentative Schedule for Summer 2013
STEP 1 - Select Enrollment Option
q 20 Days q 30 Days q Full-Time
STEP 2 - Indicate Drop-Off and Pick-Up Times
MONDAY / TUESDAY / WEDNESDAY / THURSDAY / FRIDAYDrop-Off / Drop-Off / Drop-Off / Drop-Off / Drop-Off
Pick-Up / Pick-Up / Pick-Up / Pick-Up / Pick-Up
STEP 3 - Circle the days that your child will attend the Summer Camp Program.
The total number of circled days must correspond with your Enrollment Option
(see Step 1) and also the Contract Total on your child’s Registration Form.
Number of Days ¨ June 10 11 12 13 14
Number of Days ¨ June 17 18 19 20 21
Number of Days ¨ June 24 25 26 27 28
Number of Days ¨ July 1 2 3 4 5
(July 4th closed in observance of Independence Day)
Number of Days ¨ July 8 9 10 11 12
Number of Days ¨ July 15 16 17 18 19
Number of Days ¨ July 22 23 24 25 26
Number of Days ¨ July 29 30 31 August 1 2
Number of Days ¨ August 5 6 7 8 9
Number of Days ¨ August 12 13 14 15 16
Number of Days ¨ August 19 20 21 22 23
Total Number of Days Selected ¨
STEP 4 - Please return Contract along with Activities Fee to:
Hildebrandt Learning Centers
Rainbow Learning Center
VA Medical Center, Building #3
1700 S. Lincoln Avenue
Lebanon, PA 17042