Camp Mind Power 
Pre-enroll by 12/1/08 (no cost or obligation) and receive $100 off enrollment - 
To pre-enroll fill out parent/student info and submit 
$100 will be deducted from final payment  if you procede wiith final enrollment
                                                                


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Parent/Guardian Information
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Name:  
Address :
City :
State :       zip:
T elephone:      e-mail:

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Student Information
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Name:
Address:

City:   State:   Zip:
e-mail:
Birthdate:      Male      Female
Entering grade (fall 2008):



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Fees/Payment
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Full Payment
$100 non-refundable deposit (balance due 6/1/09)
Day student, deduct $180 from final payment

Authorization to charge balance to credit card on
     6/1/09
Card type (Visa, MC, Discover): 
Card Number:    Expires:
Security number (on signature panel):
Card Holder:
Billing zip code:
Signature:

Check enclosed (payable to Camp Mind Power)
___________________________________________________________________________________      Cancellation Policy:
Notification of withdrawal must be in writing to Camp Mind Power.  No refunds will be given after June 30, 2008.
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