Maximum Teen Travel Camp Application
CAMPER'S NAME (First) *	(Last)*	Sex*	D.O.B.* mm/dd/yyyy
Campers Email Address*	Primary Address*	City, St Zip*


	8 WEEKS	FULL 8 WEEK SESSION July 2 - Aug 24, 2012	$6499
	4 WEEKS	Any 4 consecutive weeks	$4999**
	5 WEEKS	Any 5 weeks (must include 4consecutive weeks)	$5379**
	6 WEEKS	Any 6 weeks (must include 4consecutive weeks)	$5749**
	7 WEEKS	Any 7 week period	$6129
*Add an additional $350 for airfare if your 4,5,6 week session includes the aire trip (week 8 August 20-24)
CHECK EACH WEEK CAMPER WILL ATTEND 1 2 3 4 5 6 7 8
PLEASE INDICATE TEE SHIRT SIZE (Adult sizes) SM MED LG XL

I have read and agree to the terms and conditions and cancellation policy of Maximum Teen Travel *

Parent's/Guardian's Name Signing This Form

Do you require the additional Airfare?

Extra Airfare

$0.00

Calculated Total

$0.00

Enter the amount you would like to pay:

Visa - Mastercard - American Express - Discover cards accepted This will appear on your statement as Maximum Tours.

Maximum Tours: Teen Travel: Long Island, NY