13 Weeks of FUN educational summer activities for ages 18 mo. – 7 years Let’s Get “Buggy” - May 31 – June 3 Outdoor Play - June 6 – 10 Wild Wild West - June Passport Around the World - June ND Ukrainian Dance Festival - July (Ages 4 and Older) Story Telling (under 4 yrs.) – July Mad Science - July Rocks and Rocks – August Amazing Animals– August Young Chefs– August Grasslands Montessori Academy 2016 America, America! - July 5 – 8 ND Ukrainian Dance Festival - July (Ages 4 and older) Makin’ Music (under 4 yrs.) - July Infinity and Beyond - June 27 – July 1 Week 12 Week 13 Closed August 29 – September 2 for School Year Preparations Creating an Artist– August

Grasslands Montessori Academy Summer Adventure Camp 2016 Enrollment Form (Please fill out one form per child.) __ Week 1 (5/31-6/3) - “Let’s Get Buggy” __ Week 2 (6/6-6/10) - “Outdoor Play” __ Week 3 (6/13-6/17) - “Wild Wild West” __ Week 4 (6/20-6/24) – “Passport Around the World” __ Week 5 (6/27-7/1) – “Infinity and Beyond” __ Week 6 (7/5-7/8) – “America, America!” __ Week 7 (7/11-7/15) – “ NDUDA wk. 1 or Makin’ Music” __ Week 8 (7/18-7/22) – “ NDUDA wk. 2 or Story Telling” __ Week 9 (7/25-7/29) – “Mad Science” __ Week 10 (8/1-8/5) – “Rocks and Rocks” __ Week 11 (8/8-8/12) – “Amazing Animals” __ Week 12 (8/15-8/19) – “Young Chefs” __ Week 13 (8/22-8/26) – “Creating an Artist” Child’s Name:Age/DOB:Male Female Address: City:State:Zip Code: Parent or Legal Guardian’s Name: Telephone: Rates and Fees Registration fees……………….New Student: $50……………..Current GMA Student: none Early Childhood All Day (3 years and older)- Hours: 8:30am – 3:30pm, daily Three month commitment:$710 per month plus $25 per month activity fee Month by month:$740 per month plus $25 per month activity fee Weekly:$190 per week plus $10 per week activity fee Early Childhood Extended Day Care (3 years and older)- Available Hours: from 7:30am - 6pm, daily Three month commitment:$810 per month plus $25 per month activity fee Month by Month:$845 per month plus $25 per month activity fee Weekly:$220 per week plus $10 per week activity fee Toddler All Day (18 months – 36 months)- Hours: 8:30am – 3:30pm, daily Three month commitment:$730 per monthplus $25 per month activity fee Month by Month:$760 per month plus $25 per month activity fee Weekly:$195 per week plus $10 per month activity fee Toddler Extended Day Care (18 months – 36 months)- Available Hours: from 7:30am – 6pm, daily Three month commitment:$810 per month plus $25 per month activity fee Month by Month:$845 per month plus $25 per month activity fee Weekly:$220 per week plus $10 per month activity fee. Two weeks notice is required in order to attend any workshop. Any changes or cancellations to the workshops signed up for must be made 48 hours in advance of workshop begin date. Registration and first month’s/week’s Activity Fees are due at the time of enrollment. Monthly camp tuition is due on the 1 st day of each month and considered late by the 5 th. A $50 late fee will be applied to any late payment or unpaid balance. Extended Care fees will be billed monthly and due by the 5 th day of the following month. A $50 late fee will also apply to any late or unpaid balances. By signing I agree to the Terms and Conditions above and also accept financial responsibility for all workshops signed up for on this form according to the Terms and Conditions. Parent/Guardian Signature _____________________________ Date ___________ __ Three month commitment (June - August) Month by Month: __ June __ July __ August Please indicate the workshops you wish the above child to attend. Or sign up by the week: