PAINTBOX SUMMER CAMP REGISTRATION FORM

Please return to Jeanne Waxgiser, Paintbox Preschool, 321 High Street, Cumberland, RI 02864



Child’s Name:

Date of Birth M/D/YR:  _______________

Address (Street, Town, State, Zip):
______________________________________________
Home Phone Number: ________________ Cell Phone:________________ 

Email:  _______________________________

Does the child have any allergies?  Yes _____   No _____  Please list:  __________________________________________



Name the camp/s you are registering for:  ______________________________________

_______________________________________________________________________
Please submit half of the balance due to hold a spot.


Total Amount Due is $100 per camp Amount Sent:  ________________________ 

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