Purchase Day Camp 2023 Enrollment Application

Fill out the application below and click "Recalculate Total" at the bottom of the form to continue.


Camper's Last: First: Birthdate: Age (on 7/1/23):

Street: City: State: Zip: Home Phone: ()-

Gender: School 2022-23: School 2023-24:

Special Placement Requests: Camper/Friend: Grade Level (if different from above):

Allergies, Medical Conditions, or Special Needs if any?

Choose your program and number of weeks!
(Camp runs for 8 weeks from Monday June 26th to Friday August 18th, 2023)
 
Full Day
Mini Day
Half Day
Hours
9am - 4pm
9am - 1:45pm & 2pm
9am - 12:10pm
Camper Eligibility
All Campers Eligible
Entering Kindergarten & Younger
Pre-K Only 3 by December 31, 2023
Fee includes Lunch PLUS
Bus* or Extended Hours,
Towel Service, Camp Bag & Shirt
Fee includes Lunch PLUS
AM Bus* or AM Extended Hours
,
Towel Service, Camp Bag & Shirt
Fee includes AM Bus* or
AM Extended Hours,
Towel Service, Camp Bag & Shirt
2 Weeks
3 Weeks
4 Weeks
5 Weeks
6 Weeks
7 Weeks
8 Weeks
Choose Which Weeks You Want - Check Each Week Requested

June 26 - June 30


July 3 - 7
(closed July 4)

July 10 - 14


July 17 - 21


July 24 - 28


July 31 - August 4


August 7 - 11


August 14 - 18

Customize Your Options!

Bus or
Extended Hours
Service Options
*Please see transportation areas here.
Deductions apply for:
AM Service
or
PM Service
or
Both

Full Day
Mini Day
Half Day
AM Service (Choose One)
Deduct $200 for No AM Service
AM Service (Choose One)
Deduct $200 for No AM Service
AM Service (Choose One)
Deduct $200 for No AM Service
PM Service(Choose One)
Deduct $200 for No PM Service
Mid-Day Service
Available in Purchase, West Harrison and Rye Brook Only
PM Service
Not Available
Lunch
(Included for Full and Mini)
Lunch Plan Declined
Lunch Plan Declined
Lunch is not part of the
Half Day Program
Discounts - Check All That Apply
Sibling Discount Each Child
Camper entering 9th Grade
Camper entering 10th Grade

Mother or Guardian Contact Information:



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Father or Guardian Contact Information:



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Total: $8900

A deposit of $1800 is required with this application.




3095 Purchase Street • Purchase, NY 10577 • Tel. 914-949-2636 • Fax. 914-949-0955
office@purchasehouse.com