DICE

Summer Program 2018 Enrollment Form

Please complete the form below and submit along with an initail deposit of $350. This initial deposit will be later applied towards the payment for the enrolled weeks. You will receive a confirmation email after your succesful enrollment along with the payment.

Make sure that you have read our Summer Program policies, requirements, pricing and general information. Sibling discount (if applicable) will be applied at the time of remaining balance payment. Thank you. Call us at (248) 962-3678 for more information or if you have any questions.

  STUDENT INFORMATION
 
*First Name: *Last Name:
*Date of Birth:  mm/dd/yyyy * Gender
*Grade Completed:
 
  PARENT/GUARDIAN INFORMATION
 
*Father's Name: *Father's Phone:
*Mother's Name: *Mother's Phone:
* Primary Email: Alternate Email:
* Address: * City:
* State: * Zip Code:
 
  EMERGENCY CONTACT INFORMATION
 
*1st Contact Name: *1st Contact Phone:
*2nd Contact Name: *2nd Contact Phone:
 
  Days/Weeks Interested
 

You must select a minimum of 3 weeks with atleast 3 days in each of those weeks.

June 17

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Mon 06/18




Tue 06/19




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June 24

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Mon 06/25




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July 01

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    Holiday
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July 08

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Mon 07/09




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July 15

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Mon 07/16




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July 22

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Mon 07/23




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July 29

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Mon 07/30




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Wed 08/01




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August 05

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Mon 08/06




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August 12

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Mon 08/13




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August 19

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Mon 08/20




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August 26

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Please click the button below to enroll and make an initial deposit of $350.
This deposit will be applied towards your payment for enrolled weeks later.


   

PayPal

By clicking the 'Submit Enrollment' button above, you agree to our Terms and that you have read our Summer Program Enrollment Policies.


Copyright © Detroit Indian Center All Rights Reserved

Address: 24555 Novi Rd, Novi, MI 48375                          Phone: (248) 962-3678                 Email: detroitindiancenter@yahoo.com