Prestige Rhythmic Summer Camp Registration 2017
Camper’s Last Name: ______First Name:______
DOB: ______(mm/dd/yyyy)Age: ______Gender: Female / Male (circle one)
Home Full Address: ______
Mother/Guardian’s Full Name: ______Cell phone #: ______
Email: ______
Father/Guardian’s Full Name: ______Cell phone #: ______
Email: ______
Emergency Contact #1: - Name/Relationship & Phone #: ______
Emergency Contact #2: - Name/Relationship & Phone #: ______
Circle Your Choices
for
Session, Times, Days and After Care
Session TimesDays
Week 1 / June 19 – June 23 / Full Day * Half Day AM * Half Day PM / Full Week * Mon * Tue * Wed * Thu * FriWeek 2 / June 26 – June 30 / Full Day * Half Day AM * Half Day PM / Full Week * Mon * Tue * Wed * Thu * Fri
Week 3 / July 3 – July 7* / Full Day * Half Day AM * Half Day PM / Full Week * Mon * Tue * Wed * Thu * Fri
Week 4 / July 10 – July 14 / Full Day * Half Day AM * Half Day PM / Full Week * Mon * Tue * Wed * Thu * Fri
Week 5 / July 17 – July 21 / Full Day * Half Day AM * Half Day PM / Full Week * Mon * Tue * Wed * Thu * Fri
Week 6 / July 24 – July 28 / Full Day * Half Day AM * Half Day PM / Full Week * Mon * Tue * Wed * Thu * Fri
Week 7 / July 31 – Aug 4 / Full Day * Half Day AM * Half Day PM / Full Week * Mon * Tue * Wed * Thu * Fri
Week 8 / Aug 7 – Aug 11 / Full Day * Half Day AM * Half Day PM / Full Week * Mon * Tue * Wed * Thu * Fri
Week 9 / Aug 14 – Aug 18 / Full Day * Half Day AM * Half Day PM / Full Week * Mon * Tue * Wed * Thu * Fri
Week 10 / Aug 21 – Aug 25 / Full Day * Half Day AM * Half Day PM / Full Week * Mon * Tue * Wed * Thu * Fri
*July 4th – No Camp.Week 3 – Only 4 Days. Price - $200.00
After Care (4 -5 PM) * No Thanks * Every Day * Only These Days: ______
(Please, circle your choice)
Discounts: For Prestige RGA gymnasts – 5% off;
For 3 Weeks and more – 10% off;
Sig up by June 15th – 5% off
Stop in or Email us at or more info or register
Prestige Rhythmic Gymnastics Academy. 21586 Atlantic Blvd., Unit 130, Sterling VA 20166