Please print out, fill out and mail to: Northport-East Northport Community Theater
***See Address on Bottom of Form*** Click here to return to Summer Camp
SUMMER CAMP APPLICATION
Monday, July 7, 2008 – Friday, August 8, 2008
(Final Evening performance on Friday, August 8th)
NAME
______________________________________________________________
ADDRESS
_____________________________________________________________
PHONE ________________________ E-MAIL _______________________ CELL _____________________
EMERGENCY CONTACT AND PHONE _____________________________________________________
AGE ___________ GRADE (Sept., 2008) __________
Please check which session you will be attending (price includes a mandatory camp tee shirt)
(All sessions are Monday – Friday for 5 weeks)
9:30 – 12:00 Noon ____________ $ 410.00
9:30 – 3:30 PM ____________ (Bring Lunch) 810.00
*** All FULL DAY campers will participate in the variety show and the production of
“MUSIC MAN” ***
(Day care available before and after camp days, as well as lunch hour for a fee by special arrangements with Bette, Camp Administrator)
Enclose check or charge and send to: Northport – E. Northport Community Theater
P. O. Box 572
Northport, NY 11768
CHARGE: Visa ______ Card # ___________________________________
Master Card ______ Expiration Date ___________________________
FULL NAME AND FULL ADDRESS (As it appears on credit card)
_____________________________________________________________________________________________
P.O. Box 572 , Northport, New York 11768
(631) 896-5970 bdsilver@optonline.net
www.northportcommunitytheater.org