"*" indicates required fields After School Enrichments 2022-2023 WAVERLY BELMONT ELEMENTARY TUESDAYS - Grades: K-4th - WB Library Cost: $165.00/per 6 week session Waverley Belmont - LEGO CLUB Session #1 - 3:00pm-4:30pm Quantity September 6, 13, 20, 27, October 4, 18 Price: $165.00 Quantity Waverley Belmont - LEGO CLUB Session #2 - 3:00pm-4:30pm Quantity October 25, November 1, 15, 22, 29, December 6 Price: $165.00 Quantity Waverly Belmont - LEGO CLUB Session #3 - 3:00pm-4:30pm Quantity FULL...NO SPACES AVAILABLE JAN 24,31, FEBRUARY 7,14,21,28 Price: $165.00 Quantity Waverly Belmont - LEGO CLUB Session #4 - 3:00pm-4:30pm Quantity FULL- NO SPACES AVAILABLE MARCH 7,21,28,APRIL 4,11,18 Price: $165.00 Quantity JULIA GREEN ELEMENTARY TUESDAYS - Grades: K-4th Cost: $165.00/per 6 week session Julia Green - LEGO CLUB Session #1 - 3:00pm-4:30pm Quantity September 6, 13, 20, 27, October 4, 18 Price: $165.00 Quantity Julia Green - LEGO CLUB Session #2 - 3:00pm-4:30pm Quantity October 25, November 1, 15, 22, 29, December 6 Price: $165.00 Quantity Julia Green - LEGO CLUB Session #3 - 3:00pm-4:30pm Quantity Jan 24, 31 February 7, 14, 21, 28 Price: $165.00 Quantity Julia Green - LEGO CLUB Session #4 - 3:00pm-4:30pm Quantity March 7, 21, 28, April 4, 11, 18 Price: $165.00 Quantity Participant Information BUILDER #1 First Name* Last Name* School* Grade* K1st2nd3rd4th5th Sex* MaleFemale Birthdate* MM slash DD slash YYYY Additional Builder? Additional Builder BUILDER #2 First Name Last Name School Grade K1st2nd3rd4th5th Sex MaleFemale Birthdate MM slash DD slash YYYY Household/Adult Primary Contact Relationship* Mother Father Other Other Relationship First Name* Last Name* Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone Number* Alternate Phone Email* Emergency Contact Name* Emergency Contact Phone* Untitled I give my permission for Camp Brick to use my child's picture for marketing purposes?* YesNo Payment Information SESSIONS FILL QUICKLY... PAY NOW TO RESERVE YOUR SPOT! REGISTRATION IS ON A FIRST COME FIRST SERVE BASIS ONCE PAYMENT IS RECEIVED REGISTRATION TOTAL Payment Method* Check/Money Order Credit Card Camp Brick Gift Card A $7 Processing Fee has been added to your order Price: Credit Card American Express Discover MasterCard Visa Supported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Please make your checks payable to Camp Brick and mail to: Jennifer Thayer 1105C North 8th Street Nashville, TN 37207 If using a Camp Brick Gift Card please mail payment by check and include the card. Please send payments to: Jennifer Thayer 1105C North 8th Street Nashville, TN 37207 * ALL FIELDS REQUIRED Comments This field is for validation purposes and should be left unchanged. Δ
