Please print out this form and mail with a check made out to Durham Chinese School for $50 deposit to reserve your child's placement. No registration fee if you register before May 1. After May 1, you need to include an additional $30 per child with your deposit. You must cancel at least three weeks prior to the registered camp week to receive a full refund, less the $50 deposit. No refunds are available for cancellations less than three weeks prior to the signed camp week. Full payment is due on the first of the month for weeks attending in that month.

The cost:

• $150/week for children ages 3-5
• $125/ week for children ages 6 & up
• 1 or more siblings receive a 10% discount
• Register before May 1 and $30 registration fee will be waived!

Extended Day Option is also available from 1-5pm for an additional $15 per day. *You must be signed up for the morning program to attend this afternoon option.


Little Panda and Durham Chinese School's mailing address is: 625 East NC Hwy 54, Durham, NC 27713.

Session Offerings (8:30am-1pm)                                              

Summer Camp Week of:                                     Extended Day
___June 14                                                       ___ June 14

___June 21                                                       ___ June 21

___June 28                                                       ___June 28 

___July 5                                                          ___July 5

___July 12                                                        ___July 12

___July 19                                                       ___July 19

___July 26                                                       ___July 26

___Aug 2                                                        ___Aug 2

___Aug 9                                                        ___Aug 9   

___Aug 16                                                      ___ Aug 16                         


Campers should bring a lunch and snack. There will be a snack time in the morning AND during the extended day program. Due to space and time constraints, please do not send food that needs to be warmed or put into the refrigerator.

*** Please check here ___ if your information has changed***

Student Name:_______________________________________________________________

Birthday:____________________________ Age:____ (must be 3 by June 14, 2010) Sex:____

Allergies:_____________________________________________________________________

____________________________________________________________________________

Home Address:

Street: _____________________________________________________________________

City, State, Zip: ______________________________________________________________

Home Phone: (_____)_______________

Parent Name:____________________________________ Cell Ph: (_____)_______________

Work Ph:(_____)_________________ Email:________________________________________

Parent Name:____________________________________ Cell Ph:(_____)________________

Work Ph:(_____)_________________ Email:________________________________________

Emergency Contact Name and Phone:

____________________________________________________________________________

Persons Authorized to pick up your child: 

____________________________________________________________________________

How did you hear about Little Panda? _____________________________________________


Guardian Signature:______________________________      Date:__________