Please print this page, complete information below and mail with payment to:
Discovery Director Nick Mercurio
31 Yellow Cote Road
Oyster Bay, New York 11771
Child’s Name: _____________________ Gender: __________ Age: ________
Birth Date ________ Grade ______
Child’s Name: _____________________Gender: __________ Age: _________
Birth Date ________ Grade ______
Child’s Name: _____________________ Gender: __________Age: _________
Birth Date ________ Grade ______
Name of Parent or Guardian:_____________________________________
Street Address _______________________________________________
City __________________________ State _________ Zip _________
Home Phone _________________ Emergency Phone __________________
E-mail address : Please send an email to discoveryrocks@mac.com to ensure that we have your correct, current address.
My child/children would be interested in:
__Voyager Program (3-4 year olds)
__Navigator Program (self-contained 5 year olds)
__Adventurer Program (6 & 7 year olds)
__ Explorer Program (8-12 year olds)
__Junior Counselors (13, 14, & 15 year olds)
My Voyager (ages 3-4) child/children will attend for: (choose one)
__Session 1, Half day, 5 mornings each week
__Session 2, Half day, 5 mornings each week
__Session 1 and 2, Half day, 5 mornings each week
__Session 1, Full day, 5 full days each week
__Session 2, Full day, 5 full days each week
__Session 1 and 2, Full day, 5 full days each week
__Session 1, Full day, 3 full days each week
__Session 2, Full day, 3 full days each week
__Session 1 and 2, Full day, 3 full days each week
My Navigator, Adventurer, Explorer, and/or Junior Counselor (ages 5-15) child/children will attend for: (choose one)
__Full Day, Session 1
__Full Day, Session 2
__Full Day, Sessions 1 and 2
Parent’s Signature: ________________________________________
Date: _________
In an effort to make your child’s summer experience at Discovery as positive as possible, please indicate any special requests, concerns or knowledge about your child that you would like to share with us.