Summer Program Registration

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Info for Summer Program

2023 Summer Program Registration Form
(9 - 12, 12:30 - 3:30 or 9 - 3:30pm)
Student's Name*
First Last
Age*
Please enter a number from 5 to 13.
Players age 5 - 7 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
I am a Potomac Swim & Tennis Club Member
- Yes
- No
Packages (Multiple Weeks)
Package Options [NMbr]
- 4 Weeks of Morning (9-12) $1200 [NON-MEMBER]
- 4 Weeks of Afternoon (12:30-3:30) $1200 [NON-MEMBER]
- 4 Weeks of Full Day (9-3:30) $2120 [NON-MEMBER]
- 8 Weeks of Morning (9-12) $2240 [NON-MEMBER]
- 8 Weeks of Afternoon (12:30-3:30) $2240 [NON-MEMBER]
- 8 Weeks of Full Day (9-3:30) $4000 [NON-MEMBER]
- Nothing/Clear
Package Options [Mbr]
- 4 Weeks of Morning (9-12) $1020 [MEMBER]
- 4 Weeks of Afternoon (12:30-3:30) $1020 [MEMBER]
- 4 Weeks of Full Day (9-3:30) $1810 [MEMBER]
- 8 Weeks of Morning (9-12) $1910 [MEMBER]
- 8 Weeks of Afternoon (12:30-3:30) $1910 [MEMBER]
- 8 Weeks of Full Day (9-3:30) $3400 [MEMBER]
- Nothing/Clear
Select Desired Package Weeks (4 or 8)
- Week 0p: June 12 - 16
- Week 1p: June 19 - 23
- Week 2p: June 26 - 30
- Week 3p: July 5 - 7
- Week 4p: July 10 - 14
- Week 5p: July 17 - 21
- Week 6p: July 24 - 28
- Week 7p: July 31 - Aug 4
- Week 8p: August 7 -11
- Week 9p: August 14 - 18
Additional weeks can be purchased at the discounted rate via emailing admin@passacademypstc.com
Individual Weeks
Week 0n: June 12 - 16 [NMbr]
- Morning Camp (Wk0) $330 [NON-MEMBER]
- Afternoon Camp (Wk0) $330 [NON-MEMBER]
- Full Day Camp (Wk0) $590 [NON-MEMBER]
- Nothing/Clear
Week 0n: June 12 - 16 [Mbr]
- Morning Camp (Wk0) $290 [MEMBER]
- Afternoon Camp (Wk0) $290 [MEMBER]
- Full Day Camp (Wk0) $510 [MEMBER]
- Nothing/Clear
Week 1n: June 19 - 23 [NMbr]
- Morning Camp (Wk1) $330 [NON-MEMBER]
- Afternoon Camp (Wk1) $330 [NON-MEMBER]
- Full Day Camp (Wk1) $590 [NON-MEMBER]
- Nothing/Clear
Week 1n: June 19 - 23 [Mbr]
- Morning Camp (Wk1) $290 [MEMBER]
- Afternoon Camp (Wk1) $290 [MEMBER]
- Full Day Camp (Wk1) $510 [MEMBER]
- Nothing/Clear
Week 2n: June 26 - 30 [NMbr]
- Morning Camp (Wk2) $330 [NON-MEMBER]
- Afternoon Camp (Wk2) $330 [NON-MEMBER]
- Full Day Camp (Wk2) $590 [NON-MEMBER]
- Nothing/Clear
Week 2n: June 26 - 30 [Mbr]
- Morning Camp (Wk2) $290 [MEMBER]
- Afternoon Camp (Wk2) $290 [MEMBER]
- Full Day Camp (Wk2) $510 [MEMBER]
- Nothing/Clear
Week 3n: July 5 - 7 (3 days) [NMbr]
- Morning Camp (Wk3) $200 [NON-MEMBER]
- Afternoon Camp (Wk3) $200 [NON-MEMBER]
- Full Day Camp (Wk3) $360 [NON-MEMBER]
- Nothing/Clear
Week 3n: July 5 - 7 (3 days) [Mbr]
- Morning Camp (Wk3) $170 [MEMBER]
- Afternoon Camp (Wk3) $170 [MEMBER]
- Full Day Camp (Wk3) $310 [MEMBER]
- Nothing/Clear
Week 4n: July 10 - 14 [NMbr]
- Morning Camp (Wk4) $330 [NON-MEMBER]
- Afternoon Camp (Wk4) $330 [NON-MEMBER]
- Full Day Camp (Wk4) $590 [NON-MEMBER]
- Nothing/Clear
Week 4n: July 10 - 14 [Mbr]
- Morning Camp (Wk4) $290 [MEMBER]
- Afternoon Camp (Wk4) $290 [MEMBER]
- Full Day Camp (Wk4) $510 [MEMBER]
- Nothing/Clear
Week 5n: July 17 - 21 [NMbr]
- Morning Camp (Wk5) $330 [NON-MEMBER]
- Afternoon Camp (Wk5) $330 [NON-MEMBER]
- Full Day Camp (Wk5) $590 [NON-MEMBER]
- Nothing/Clear
Week 5n: July 17 - 21 [Mbr]
- Morning Camp (Wk5) $290 [MEMBER]
- Afternoon Camp (Wk5) $290 [MEMBER]
- Full Day Camp (Wk5) $510 [MEMBER]
- Nothing/Clear
Week 6n: July 24 - 28 [NMbr]
- Morning Camp (Wk6) $330 [NON-MEMBER]
- Afternoon Camp (Wk6) $330 [NON-MEMBER]
- Full Day Camp (Wk6) $590 [NON-MEMBER]
- Nothing/Clear
Week 6n: July 24 - 28 [Mbr]
- Morning Camp (Wk6) $290 [MEMBER]
- Afternoon Camp (Wk6) $290 [MEMBER]
- Full Day Camp (Wk6) $510 [MEMBER]
- Nothing/Clear
Week 7n: July 31 - Aug 4 [NMbr]
- Morning Camp (Wk7) $330 [NON-MEMBER]
- Afternoon Camp (Wk7) $330 [NON-MEMBER]
- Full Day Camp (Wk7) $590 [NON-MEMBER]
- Nothing/Clear
Week 7n: July 31 - Aug 4 [Mbr]
- Morning Camp (Wk7) $290 [MEMBER]
- Afternoon Camp (Wk7) $290 [MEMBER]
- Full Day Camp (Wk7) $510 [MEMBER]
- Nothing/Clear
Week 8n: Aug 7 - 11 [NMbr]
- Morning Camp (Wk8) $330 [NON-MEMBER]
- Afternoon Camp (Wk8) $330 [NON-MEMBER]
- Full Day Camp (Wk8) $590 [NON-MEMBER]
- Nothing/Clear
Week 8n: Aug 7 - 11 [Mbr]
- Morning Camp (Wk8) $290 [MEMBER]
- Afternoon Camp (Wk8) $290 [MEMBER]
- Full Day Camp (Wk8) $510 [MEMBER]
- Nothing/Clear
Week 9n: Aug 14 - 18 [NMbr]
- Morning Camp (Wk9) $330 [NON-MEMBER]
- Afternoon Camp (Wk9) $330 [NON-MEMBER]
- Full Day Camp (Wk9) $590 [NON-MEMBER]
- Nothing/Clear
Week 9n: Aug 14 - 18 [Mbr]
- Morning Camp (Wk9) $290 [MEMBER]
- Afternoon Camp (Wk9) $290 [MEMBER]
- Full Day Camp (Wk9) $510 [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 prior to the start of the program are subject to fee charges of 6%. No refunds after the start of the program.
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

2023 Summer Program Registration Form(9 - 12, 12:30 - 3:30 or 9 - 3:30pm)

Parent Information

Packages (Multiple Weeks)

Individual Weeks

Medical Authorization & Release

2023 Summer Program Registration Form
(9 - 12, 12:30 - 3:30 or 9 - 3:30pm)