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Youth Camp 2013

Gujarati Samaj,Inc. 5331 Royal W oods Parkway Tucker,Georgia 30084

Camp Date: June3rd to June 14th - Monday to Friday Drop off: 8:45 AM to 9:00 AM | Pick-up 3:45 PM to 4:00 PM

Phone: 770.496.008 Email: info@gsatlanta.org

Free: Snack, Lunch, Art and Craft, T Shirt will be provide to all

Application form to be completed by Parents/Guardian and mail to Gujarati Samaj address above Applicant Info: Type : Camper (CA) / Counselor (CS) T Shirt Full Name M/F Size

Type

Birth Date (MM/DD/YY)

My Child is Allergic To

Address: City:

State:

Phone Home: (

)

Cell: (

)

Zip: Business: (

)

Email Address Parent/Guardian:

Last Name

First Name

Relation to Child

1 2 Emergency Contact Name : Phone Home: (

)

Cell: (

)

Business: (

)

Emergency Email Address: Are You Samaj Member? Yes/No

Membership#:

Payment Type: Check / Cash

Check#:

Are you available to Volunteer? Yes / No

Comments:

Total Amount:

Signature of Parent/Guardian Type Camper Assistant Counselor Counselor

Bank Name:

Date Age 5 to 13 14 15 and up

$150 $75 $75

Non Member $175 $100 $100

Deadline April 30th 2013 March 30th 2013 March 30th 2013

For more information, please contact Varsha Patel Ketki Patel Vasudev Patel

678-469-5854 404-432-3691 404-401-4404

varshapatel55@gmail.com ketki1956@hotmail.com vasu4bjp@yahoo.com


Gujarati Samaj of Atlanta Holi Flyer 2013  

GUJARATI SAMAJ OF ATLANTA HOLI FLYER

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