Summer Program Registration

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Info for Summer Program

2022 Summer Program Registration Form
(9 - 12, 12:30 - 3:30 or 9 - 3:30pm)
Student's Name*
First Last
Birthdate*
MM slash DD slash YYYY
Age*
Please enter a number from 5 to 15.
Players age 5 - 6 may only register for Morning Programs
Parent Information
Parent's Name*
First Last
Address*
Street Address City State ZIP Code
Parent's Email Address*
Enter Email Confirm Email
Home Phone*
Parents's Mobile Phone
Parent's Office Phone
Packages (Multiple Weeks)
Package Options
- 4 Weeks of Morning (9-12) $1080 [NON-MEMBER]
- 4 Weeks of Afternoon (12:30-3:30) $1080 [NON-MEMBER]
- 4 Weeks of Full Day (9-3:30) $1950 [NON-MEMBER]
- 8 Weeks of Morning (9-12) $2020 [NON-MEMBER]
- 8 Weeks of Afternoon (12:30-3:30) $2020 [NON-MEMBER]
- 8 Weeks of Full Day (9-3:30) $3630 [NON-MEMBER]
- 4 Weeks of Morning (9-12) $920 [MEMBER]
- 4 Weeks of Afternoon (12:30-3:30) $920 [MEMBER]
- 4 Weeks of Full Day (9-3:30) $1660 [MEMBER]
- 8 Weeks of Morning (9-12) $1720 [MEMBER]
- 8 Weeks of Afternoon (12:30-3:30) $1720 [MEMBER]
- 8 Weeks of Full Day (9-3:30) $3090 [MEMBER]
- Nothing/Clear
IF MORNING Package Selected Above: Select Desired Weeks (4 or 8)
- Week 0mp: June 13 - 17
- Week 1mp: June 20 - 24
- Week 2mp: June 27 - July 1
- Week 3mp: July 5 - 8
- Week 4mp: July 11 - 15
- Week 5mp: July 18 - 22
- Week 6mp: July 25 - 29
- Week 7mp: August 1 - 5
- Week 8mp: August 8 -12
- Week 9mp: August 15 - 19
Additional weeks can be purchased at the discounted rate via emailing admin@passacademypstc.com
IF AFTERNOON Package Selected Above: Select Desired Weeks (4 or 8)
- Week 0ap: June 13 - 17
- Week 1ap: June 20 - 24
- Week 2ap: June 27 - July 1
- Week 3ap: July 4 - 8
- Week 4ap: July 11 - 15
- Week 5ap: July 18 - 22
- Week 6ap: July 25 - 29
- Week 7ap: August 1 - 5
- Week 8ap: August 8 -12
- Week 9ap: August 15 - 19
Additional weeks can be purchased at the discounted rate via emailing admin@passacademypstc.com
IF FULL DAY Package Selected Above: Select Desired Weeks (4 or 8)
- Week 0fp: June 13 - 17
- Week 1fp: June 20 - 24
- Week 2fp: June 27 - July 1
- Week 3fp: July 4 - 8
- Week 4fp: July 11 - 15
- Week 5fp: July 18 - 22
- Week 6fp: July 25 - 29
- Week 7fp: August 1 - 5
- Week 8fp: August 8 - 12
- Week 9fp: August 15 - 19
Additional weeks can be purchased at the discounted rate via emailing admin@passacademypstc.com
Individual Weeks
Week 0n: June 13 - 17
- Morning Camp (Wk0) $300 [NON-MEMBER]
- Afternoon Camp (Wk0) $300 [NON-MEMBER]
- Full Day Camp (Wk0) $540 [NON-MEMBER]
- Morning Camp (Wk0) $260 [MEMBER]
- Afternoon Camp (Wk0) $260 [MEMBER]
- Full Day Camp (Wk0) $460 [MEMBER]
- Nothing/Clear
Week 1n: June 20 - 24
- Morning Camp (Wk1) $300 [NON-MEMBER]
- Afternoon Camp (Wk1) $300 [NON-MEMBER]
- Full Day Camp (Wk1) $540 [NON-MEMBER]
- Morning Camp (Wk1) $260 [MEMBER]
- Afternoon Camp (Wk1) $260 [MEMBER]
- Full Day Camp (Wk1) $460 [MEMBER]
- Nothing/Clear
Week 2n: June 27 - July 1
- Morning Camp (Wk2) $300 [NON-MEMBER]
- Afternoon Camp (Wk2) $300 [NON-MEMBER]
- Full Day Camp (Wk2) $540 [NON-MEMBER]
- Morning Camp (Wk2) $260 [MEMBER]
- Afternoon Camp (Wk2) $260 [MEMBER]
- Full Day Camp (Wk2) $460 [MEMBER]
- Nothing/Clear
Week 3n: July 5 - 8 (4 days)
- Morning Camp (Wk3) $240 [NON-MEMBER]
- Afternoon Camp (Wk3) $240 [NON-MEMBER]
- Full Day Camp (Wk3) $430 [NON-MEMBER]
- Morning Camp (Wk3) $210 [MEMBER]
- Afternoon Camp (Wk3) $210 [MEMBER]
- Full Day Camp (Wk3) $370 [MEMBER]
- Nothing/Clear
Week 4n: July 11 - 15
- Morning Camp (Wk4) $300 [NON-MEMBER]
- Afternoon Camp (Wk4) $300 [NON-MEMBER]
- Full Day Camp (Wk4) $540 [NON-MEMBER]
- Morning Camp (Wk4) $260 [MEMBER]
- Afternoon Camp (Wk4) $260 [MEMBER]
- Full Day Camp (Wk4) $460 [MEMBER]
- Nothing/Clear
Week 5n: July 18 - 22
- Morning Camp (Wk5) $300 [NON-MEMBER]
- Afternoon Camp (Wk5) $300 [NON-MEMBER]
- Full Day Camp (Wk5) $540 [NON-MEMBER]
- Morning Camp (Wk5) $260 [MEMBER]
- Afternoon Camp (Wk5) $260 [MEMBER]
- Full Day Camp (Wk5) $460 [MEMBER]
- Nothing/Clear
Week 6n: July 25 - 29
- Morning Camp (Wk6) $300 [NON-MEMBER]
- Afternoon Camp (Wk6) $300 [NON-MEMBER]
- Full Day Camp (Wk6) $540 [NON-MEMBER]
- Morning Camp (Wk6) $260 [MEMBER]
- Afternoon Camp (Wk6) $260 [MEMBER]
- Full Day Camp (Wk6) $460 [MEMBER]
- Nothing/Clear
Week 7n: Aug 1 - 5
- Morning Camp (Wk7) $300 [NON-MEMBER]
- Afternoon Camp (Wk7) $300 [NON-MEMBER]
- Full Day Camp (Wk7) $540 [NON-MEMBER]
- Morning Camp (Wk7) $260 [MEMBER]
- Afternoon Camp (Wk7) $260 [MEMBER]
- Full Day Camp (Wk7) $460 [MEMBER]
- Nothing/Clear
Week 8n: Aug 8 - 12
- Morning Camp (Wk8) $300 [NON-MEMBER]
- Afternoon Camp (Wk8) $300 [NON-MEMBER]
- Full Day Camp (Wk8) $540 [NON-MEMBER]
- Morning Camp (Wk8) $260 [MEMBER]
- Afternoon Camp (Wk8) $260 [MEMBER]
- Full Day Camp (Wk8) $460 [MEMBER]
- Nothing/Clear
Week 9n: Aug 15 - 19
- Morning Camp (Wk9) $300 [NON-MEMBER]
- Afternoon Camp (Wk9) $300 [NON-MEMBER]
- Full Day Camp (Wk9) $540 [NON-MEMBER]
- Morning Camp (Wk9) $260 [MEMBER]
- Afternoon Camp (Wk9) $260 [MEMBER]
- Full Day Camp (Wk9) $460 [MEMBER]
- Nothing/Clear
Total Fees
$0.00
Credit Card*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Medical Authorization & Release
Camper Name*
First Last
Camper Condition*
- By checking this box it is understood that the student is in overall good physical health. If your child has a physical condition that may limit or restrict participation in certain activities, a physician’s note granting permission to participate in such activities must be presented prior to the first camp session.
Date of Medical Authorization*
MM slash DD slash YYYY

By dating above, in an emergency, when I/we cannot be contacted, I/we hereby authorize the staff of the Pass Academy to take my/our child to the emergency room of the nearest hospital. I/we authorize that hospital and its medical staff to provide treatment deemed necessary for the well-being of my/our child.
Date of Parent Release*
MM slash DD slash YYYY

By dating above, I agree to hold the Pass Academy and Potomac Swim & Tennis Club harmless for injury or loss that may occur as a result of my participation in Pass Academy activities.
Cancellation Policy*
- By checking this box I accept the following policy. All refunds are subject to fee charges of 6%.
Permission for Photo Use*
- Yes
- No
I give permission for photos of my child participating in Pass Academy at Potomac Swim & Tennis Club programs to be taken and used for the Pass Academy Website and/or Facebook page. We understand that if students are identified, only their first names will be used.
Additional Information (optional)

Summer Program Registration

2022 Summer Program Registration Form(9 - 12, 12:30 - 3:30 or 9 - 3:30pm)

Parent Information

Packages (Multiple Weeks)

Individual Weeks

Medical Authorization & Release

2022 Summer Program Registration Form
(9 - 12, 12:30 - 3:30 or 9 - 3:30pm)