2018 Lily Pad Summer Camp Registration Form

Info:

The Lily Pad Summer Camp is a summer program, held at the Lily Pad School, designed to introduce all children (Kindergarten-5th Grade) to the Chinese Culture. Students will take daily Mandarin Language classes, hands-on immersion, as well as participate in many culture-related enrichment activities. Our goal is to give children insight and appreciation of the Chinese culture.

Camp Sessions:
Session 1: June 18-22, 2018
Session 2: June 25-29, 2018
Session 3: July 9-13, 2018
Session 4: July 16-20, 2018

Camp Hours:
8:00 AM-4:00 PM
**There will be a Closing Ceremony/Art Gallery Exhibit on July 20st at 2:00pm. Camp ends after the Closing Ceremony - please make arrangements to pick up your children after the event.

Location:
The Quarries Church Recreational Center
11400 North MOPAC Expressway
Austin, TX 78759
(512) 459-6587

For more information please contact:
admin@lilypadschool.com
512-88PAD88, (512-887-2388)

1 Start 2 Medical Consent 3 Photo Consent 4 Complete

Student Information

Chinese Name

First Name *

Last Name *

Birthday *

Month

Day

Year

Email *

Gender *

Female

Male

Primary Parent/Guardian

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Country *

Email *

Home Phone *

Cell Phone

Work Phone

Secondary Parent/Guardian

First Name

Last Name

Address 1

Address 2

City

State

Zip Code

Country

Home Phone

Emergency Contact

Name *

Phone *

Address *

Student's Physician

Name

Phone

Address

Health Information

Additional Health Information

Please let us know of any food allergies your child may have, any medications he/she is taking and medical allergies:

Class Registration

Are you currently enrolled in Austin Lily Pad School? *

Fee Schedule

~~Early Registration $235 (must be registered before March 12th, full payment MUST be received by June 1st~~
**Tuition costs INCLUDE Field Trips (Bus and Admission ticket)

Camp Costs and applicable discounts after March 12th:
Camp cost 1 week: $265 or $250 (current Lily Pad Students)
Camp cost 2 weeks: $525 or $495 (current Lily Pad Students)
Camp cost 3 weeks: $785 or $743 (current Lily Pad Students)
Camp cost 4 weeks: $1045 or $992 (current Lily Pad Students)
**10% discount for additional siblings AFTER March 12th.
**Tuition costs INCLUDE Field Trips (Bus and Admission ticket)

**Refunds will not be made after June 19, 2018

The Lily Pad Camp 8:00AM - 4:00PM *

	Add For This Semester	No Thanks
Session 1: June 18-22 *	Session 1: June 18-22 - Add For This Semester	Session 1: June 18-22 - No Thanks
Session 2: June 25-29 *	Session 2: June 25-29 - Add For This Semester	Session 2: June 25-29 - No Thanks
Session 3: July 9-13 *	Session 3: July 9-13 - Add For This Semester	Session 3: July 9-13 - No Thanks
Session 4: July 16-20 *	Session 4: July 16-20 - Add For This Semester	Session 4: July 16-20 - No Thanks

Optional Purchases (please indicate number of each item, indicate 0 for none) *

	3	2	1	0
Chinese Calligraphy Brush (毛筆), $10.00 per brush *	Chinese Calligraphy Brush (毛筆), $10.00 per brush - 3	Chinese Calligraphy Brush (毛筆), $10.00 per brush - 2	Chinese Calligraphy Brush (毛筆), $10.00 per brush - 1	Chinese Calligraphy Brush (毛筆), $10.00 per brush - 0
Diabolo/Chinese Yo-yo (扯鈴), $20.00 per diabolo *	Diabolo/Chinese Yo-yo (扯鈴), $20.00 per diabolo - 3	Diabolo/Chinese Yo-yo (扯鈴), $20.00 per diabolo - 2	Diabolo/Chinese Yo-yo (扯鈴), $20.00 per diabolo - 1	Diabolo/Chinese Yo-yo (扯鈴), $20.00 per diabolo - 0

Camp Shirt *

	3	2	1	No Thanks
Youth L: $15.00 *	Youth L: $15.00 - 3	Youth L: $15.00 - 2	Youth L: $15.00 - 1	Youth L: $15.00 - No Thanks
Youth M: $15.00 *	Youth M: $15.00 - 3	Youth M: $15.00 - 2	Youth M: $15.00 - 1	Youth M: $15.00 - No Thanks
Youth S: $15.00 *	Youth S: $15.00 - 3	Youth S: $15.00 - 2	Youth S: $15.00 - 1	Youth S: $15.00 - No Thanks
Adult L: $15.00 *	Adult L: $15.00 - 3	Adult L: $15.00 - 2	Adult L: $15.00 - 1	Adult L: $15.00 - No Thanks
Adult M: $15.00 *	Adult M: $15.00 - 3	Adult M: $15.00 - 2	Adult M: $15.00 - 1	Adult M: $15.00 - No Thanks
Adult S: $15.00 *	Adult S: $15.00 - 3	Adult S: $15.00 - 2	Adult S: $15.00 - 1	Adult S: $15.00 - No Thanks

*If you do not already own a GREEN camp shirt from last year, your child will be REQUIRED to purchase one for this year. All students will need to wear their camp shirts during Field Trip days as well as Closing Ceremony.

* Tax has been included in all prices shown.

**Refunds will not be issued after June 23rd.