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Monday October 14, 2013

Columbus Day Full Day Trip

School Vacation Trips, Kindergarten - Sixth Grade

Powerhouse | East Hanover, NJ

Members: $45 Non-members: $49
All participants must bring lunch. A snack will be provided. Participants may be dropped off between 8:00am-9:00am.
Bus will depart for trip at 9:00am. Participants must be picked up by 6:00pm or late fees of $20 for the first 15 minutes
and $1 for each additional minute will be charged. All trips subject to change

Columbus Day Full Day Trips Registration Form 2013

Return in person to Mosholu Montefiore Community Center: 3450 Dekalb Ave. Bronx, NY 10467
Childs Full Name_______________________________________________ Grade________ School______________________________________
Address___________________________________________________________________________________Apt______ Zip_________________
Parents Name________________________________________________ Cell Phone # __________________________ Work #________________
Parents Name ________________________________________________ Cell Phone # __________________________ Work # _______________
Emergency Name & Phone # _______________________________________________________________________________________________

Total Member Amount Enclosed $_______ (Members have already paid the $245 Family Membership fee)
Total Non-member Amount Enclosed $_______
I give permission for my child to participate in all activities and receive emergency medical care, if needed.
I understand that MMCC may take photos for publicity purposes.
Parents Signature__________________________________________________________________________
Please indicate who is allowed to pick up your child _______________________________________________

Please check here if you

want your child to walk
____________Intial Here

Mosholu Montefiore Community Center | 3450 Dekalb Avenue Bronx, NY 10467

(718) 882-4000 www.mmcc.org