Beacon Location:
1064 Wolcott Avenue
Beacon, NY 12508
North Building (845) 831 4847
South Building (845) 831 3322
  Highland Locaton:
15 Haviland Road
Highland, NY 12528
(845) 691 7565

* Print out the forms and mail it to the address above or drop it by.

Rose Hill Manor Day Camp Registration Form

Child’s Name and Age Attending Camp:
1. _________________________________________________
2. _________________________________________________
3. _________________________________________________

Please check all that apply to you:
I will be attending the Summer Camp program the following weeks:

6/24________ 7/1________ 7/8________ 7/15________ 7/22________
7/29________ 8/5________ 8/12_______ 8/19________  

* Once you commit to these weeks, that space will be reserved for you upon payment of $60 Camp Registration Fee. You will be responsible for payment of that week, unless other arrangements have been made. No Refunds.

Camp Hours and Fees: Please mark the hours you will be attending.
9AM to 5PM $180.00 _________
Early drop available from 7:30-8:45am (pre-arranged only) ________
Late pick up available 5-5:30pm (pre-arranged only) ________

Extended Hours (ADDITIONAL $7 PER HALF AN HOUR, By Contract only):
7:00-7:30am ___________
5:30-6:00pm ___________

Parents Signature_______________________________________________

Application-Summer Camp
1064 Wolcott Avenue
Beacon, NY 12508
(845) 831-4847 North Building
(845) 831-3322 South Building
Please fill out this application completely. Accurate information is necessary so that we best serve your child. It is your responsibility to notify us immediately of any changes in employment/residence.
DATE: Family Name:
Home Address: Home Phone:
Cell Phone(Mom):
Cell Phone(Dad):
Child’s Name: Birth Date:
Mother's Name: Father's Name:
Day Care Hours/Days Needed:

Marital Status:
Hours needed during camp Extended Hours (by contract only)
7:00-7:30 AM _____
5:30-6:00 PM _____
Who is the child’s legal guardian?

Who is authorized to pick up your child?

Mother’s Employer:



Father’s Employer:



T Shirt size: