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BEST PREP SUMMER CAMP 2025

ENROLLMENT FORM FOR PS 163Q

Student Information

Student Last Name*

Student First Name*

Birthday*

Month

Day

Year

Sex*

Male

Female

Grade to be in September 2026*

K

1st

2nd

3rd

4th

5th

6th

7th

8th

Attending school*

My child is...

New to Best Prep Summer Camp

Returning to Best Prep Summer Camp

Sibling Name and Grade (if applicable):

Please note: A separate form must be submitted for each attending sibling.

Home Address*

T-shirt size*

Child Small

Child Medium

Child Large

Child X-Large

Adult Small

Adult Medium

Guardian Information

Guardian 1 Information

Guardian 1 Full Name*

Relationship to child*

Guardian 1 Email*

Phone*

Guardian 2 Information (Optional)

Guardian 2 Full Name

Relationship to child

Guardian 2 Email

Guardian 2 Phone

Emergency Contact Information

Emergency Contact Full Name*

In the case of an emergency when primary contact cannot be reached.

Emergency Contact Phone*

Emergency contact address*

Program Detail

Program Selection*

Full Day (8:00 - 3:00) $1,850

Extended Day (8:00 - 5:00) $2,150

Free Shuttle Service Available from PS 209Q (Whitestone) to PS 163Q (Flushing)

Morning (PS 209Q to PS 163Q)

Extended day 5PM dismissal (PS 163Q to PS 209Q)

** For door-to-door transportation, call main office at 718-961-2200.

Payment Method*

Check

Zelle

Credit card (4% fee)

Cash (in person)

ACS Voucher

How did you hear about us?*

Our website

School flyer

Referral

Other

If you answered “Referral” above, please specify the child’s full name and the parents’ names.

Preferred Language

Dismissal Information

My child may be picked up by the following person(s)*

My child may NOT be picked up by the following person(s)*

Please mark as "NA" if inapplicable

Student Health Information

Please check all that applies to your child*

Asthma

Behavioral/ Emotional Issues

Convulsions/ Seizures

Corrective devices (glasses, hearing aid, etc.)

None of the above

Other

Does your child take medication for any condition or illness?*

Please mark as "NA" if inapplicable

Are there any activities your child can NOT participate in? (Mark NA if not applicable)*

Please mark as "NA" if inapplicable

Does your child have any allergies?*

Please mark as "NA" if inapplicable

For children who need Epinephrine auto-injector and/or inhaler on site only:

I allow my child to carry his/her epi-pen and/ or inhaler.

(Signature required - please type your name)

Medical Form (must be dated after 8/21/2025)

Program Policy

Best Prep Policy

I have read the "Policy" (above) and understood the terms and conditions.

Is there anything else you would like us to know?

Final note:

Please review all information to ensure it is accurate.
Registration is not finalized until payment has been received.
An updated medical form must be submitted before the first day of camp (dated August 21, 2025, or later).
A representative will contact you via email within 1–2 business days after receiving your application.

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