SUMMER CAMP REGISTRATION FORM

SUMMER CAMP REGISTRATION FORM

Camp 		Dates	Cost x # of Kids =  Total
Pioneer Camp	June	$130 x _______ =  ______
Pioneer Camp 	July	$130 x _______ =  ______
Boomtown Camp 	July	$130 x _______ =  ______
AG-Samantha 	June	$150 x _______ =  ______
AG-Kirsten 	July	$150 x _______ =  ______
				Total =   ______

* Members of Dallas County Heritage Society receive a 15% discount on the price of camp(s).

Payment Methods: Make check payable to Dallas County Heritage Society OR pay by Mastercard, VISA or American Express

Type of Card: _______________________________

Name on Card: ______________________________

Daytime phone #: ____________________________

Credit Card #: _______________________________

Date of Expiration: _____/______/______

List name(s) and age(s) of student(s) being registered:

_________________________________Age: _____

Parent's Name: ______________________________

Home address: _______________________________

City__________________________Zip_________

Home phone #: ______________________________

Mail this completed form to:
Old City Park * c/o Jennifer Bransom * 1717 Gano Street * Dallas, TX 75215