I am designing a form where you fill in the info and by selecting a progrm it will tell you the price then by selecting the number of sesion it will calculate the amonunt then at the bottom i need the total to show. Here is what I have so far what Am i needing to add.
<style type="text/css">
<!--
.style1 {color: #FFFFFF}
-->
</style>
<P><SPAN class=Headline>Online Registration!</SPAN></P>
<P><SPAN class=Regular_Text>Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.</SPAN></P>
<P><SPAN class=Small_Text><STRONG>Note: Please use a separate form for each child.</STRONG></SPAN></P>
<table width=506 border=0 align="center" cellpadding=3 cellspacing=0 bgcolor=#ffffff class=text>
<tbody>
<tr bgcolor=#660099>
<td class=White_Text colspan=7 height=25><strong><font color=#ffffff size=2>Camper/Parent Information</font></strong></td>
</tr>
<tr valign=bottom>
<td colspan=2><div class=regular_text align=right><strong>Name</strong></div></td>
<td width=1> </td>
<td width=112><font class=Tiny_text>
<input name=First_name class=Form_Text_box id=First_Name tabindex=0 value="First " size=15 required="false" />
</font></td>
<td width=150><input name=Middle_Name class=Form_Text_box id=Middle_Name value="Middle" size=15 /></td>
<td width=75><font class=Tiny_text>
<input name=Last_Name class=Form_Text_box id=Last_Name value="Last " size=15 />
</font></td>
<td width=86> </td>
</tr>
<tr valign=bottom>
<td bgcolor=#bedaff colspan=2><div class=regular_text align=right><strong>Address</strong></div></td>
<td bgcolor=#bedaff> </td>
<td bgcolor=#bedaff><input name=Street class=Form_Text_box id=Street value="Street " /></td>
<td width=150 bgcolor=#bedaff><input name=City class=Form_Text_box id=City value="City" /></td>
<td width=75 bgcolor=#bedaff><select name="State" size="1" id='st'>
<option value="Choose State" selected>Choose State</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="VI">Virgin Islands</option>
<option value="AS">American Samoa</option>
<option value="GU">Guam</option>
</select></td>
<td bgcolor=#bedaff><input name=Zip class=Form_Text_box id=Zip value="Zip" size=7 maxlength="5" /></td>
</tr>
<tr>
<td colspan=2><div class=regular_text align=right><strong>Date of Birth</strong></div></td>
<td> </td>
<td><select class=Regular_Text id=Date_Of_Birth_Month tabindex=1 size=1 name=Date_Of_Birth_Month>
<option value="Select Month">Select Month</option>
<option value="January">January</option>
<option value="February">February</option>
<option value=March>March</option>
<option value=April>April</option>
<option value=May>May</option>
<option value=June>June</option>
<option value=July>July</option>
<option value=August>August</option>
<option value="September">September</option>
<option value="October">October</option>
<option value="November">November</option>
<option value=December>December</option>
</select></td>
<td width=150><select class=Regular_Text id=Date_Of_Birth_Day tabindex=1 size=1 name=Date_Of_Birth_Day>
<option value="Select Date" selected>Select Date</option>
<option value=01>01</option>
<option value=02>02</option>
<option value=03>03</option>
<option value=04>04</option>
<option value=05>05</option>
<option value=06>06</option>
<option value=07>07</option>
<option value=08>08</option>
<option value=09>09</option>
<option value=10>10</option>
<option value=11>11</option>
<option value=12>12</option>
<option value=13>13</option>
<option value=14>14</option>
<option value=15>15</option>
<option value=16>16</option>
<option value=17>17</option>
<option value=18>18</option>
<option value=19>19</option>
<option value=20>20</option>
<option value=21>21</option>
<option value=22>22</option>
<option value=23>23</option>
<option value=24>24</option>
<option value=25>25</option>
<option value=26>26</option>
<option value=27>27</option>
<option value=28>28</option>
<option value=29>29</option>
<option value=30>30</option>
<option value=31>31</option>
</select></td>
<td width=75><select class=Regular_Text id=Date_Of_Birth_Year tabindex=1 size=1 name=Date_Of_Birth_Year>
<option value="Select Year" selected>Select Year</option>
<option value=2003>2003</option>
<option value=2002>2002</option>
<option value=2001>2001</option>
<option value=2000>2000</option>
<option value=1999>1999</option>
<option value=1998>1998</option>
<option value=1997>1997</option>
<option value=1996>1996</option>
<option value=1995>1995</option>
<option value=1994>1994</option>
<option value=1993>1993</option>
<option value=1992>1992</option>
<option value=1991>1991</option>
<option value=1990>1990</option>
<option value=1989>1989</option>
<option value=1988>1988</option>
</select></td>
<td> </td>
</tr>
<tr>
<td bgcolor=#bedaff colspan=2><div class=regular_text align=right><strong>Contact Info</strong></div></td>
<td bgcolor=#bedaff> </td>
<td bgcolor=#bedaff><font class=Tiny_text>Phone <br />
</font>
<input class=Form_Text_box id=Phone size=19 name=Phone /></td>
<td width=150 bgcolor=#bedaff colspan=2><font class=Tiny_text>Email <br />
</font>
<input class=Form_Text_box id=Email size=32 name=Email /></td>
<td bgcolor=#bedaff> </td>
</tr>
<tr>
<td colspan=2><div class=regular_text align=right><strong>Schools</strong></div></td>
<td> </td>
<td><font class=Tiny_text>School <br />
</font>
<input class=Form_Text_box id=School size=15 name=School /></td>
<td width=150><font class=Tiny_text>Hebrew School</font>
<input class=Form_Text_box id=Hebrew_School name=Hebrew_School /></td>
<td class=Regular_Text colspan=2><strong class=Tiny_Text style="FONT-WEIGHT: 400">Entering Grade: <br />
</strong>
<input class=Form_Text_box id=Entering_Grade size=10 name=Entering_Grade /></td>
</tr>
<tr>
<td bgcolor=#bedaff colspan=2><div class=regular_text align=right><strong>Child's Mother</strong></div></td>
<td bgcolor=#bedaff> </td>
<td bgcolor=#bedaff><font class=Tiny_text>Mother's Name <br />
</font>
<input class=Form_Text_box id=Mother_Name size=12 name=Mother_Name /></td>
<td width=150 bgcolor=#bedaff><font class=Tiny_text>Hebrew Name</font>
<input class=Form_Text_box id=Mother_Hebrew_Name size=15 name=Mother_Hebrew_Name /></td>
<td width=75 bgcolor=#bedaff><font class=Tiny_text>Work Phone</font>
<input class=Form_Text_box id=Mother_W_Phone size=10 name=Mother_W_Phone /></td>
<td bgcolor=#bedaff><font class=Tiny_text>Cell <br />
</font>
<input class=Form_Text_box id=Mother_Cell_Phone size=10 name=Mother_Cell_Phone /></td>
</tr>
<tr>
<td colspan=2><div class=regular_text align=right><strong>Child's Father</strong></div></td>
<td> </td>
<td><font class=Tiny_text>Father's Name <br />
</font>
<input class=Form_Text_box id=Father_Name size=12 name=Father_Name /></td>
<td width=150><font class=Tiny_text>Hebrew Name</font>
<input class=Form_Text_box id=Father_Hebrew_Name size=15 name=Father_Hebrew_Name /></td>
<td width=75><font class=Tiny_text>Work Phone</font>
<input class=Form_Text_box id=Father_W_Phone size=10 name=Father_W_Phone /></td>
<td><font class=Tiny_text>Cell <br />
</font>
<input class=Form_Text_box id=Father_Cell_Phone size=10 name=Father_Cell_Phone /></td>
</tr>
<tr>
<td bgcolor=#bedaff colspan=2><div class=regular_text align=right><strong>Emergency Contact Info</strong></div></td>
<td bgcolor=#bedaff> </td>
<td valign=bottom bgcolor=#bedaff><font class=Tiny_text>Name <br />
</font>
<input class=Form_Text_box id=Emergency_Name size=12 name=Emergency_Name /></td>
<td valign=bottom width=150 bgcolor=#bedaff><font class=Tiny_text>Phone</font>
<input class=Form_Text_box id=Emergency_Phone size=15 name=Emergency_Phone /></td>
<td valign=bottom width=75 bgcolor=#bedaff><font class=Tiny_text>Relationship</font>
<input class=Form_Text_box id=Emergency_Relationship size=15 name=Emergency_Relationship /></td>
<td valign=bottom bgcolor=#bedaff> </td>
</tr>
<tr>
<td colspan=2><div class=regular_text align=right><strong>Pediatrician</strong></div></td>
<td> </td>
<td><font class=Tiny_text>Name <br />
</font>
<input class=Form_Text_box id=Doctor_Name size=12 name=Doctor_Name /></td>
<td width=150><font class=Tiny_text>Phone</font>
<input class=Form_Text_box id=Doctor_Phone size=15 name=Doctor_Phone /></td>
<td width=75> </td>
<td> </td>
</tr>
<tr valign=top>
<td class=Regular_Text bgcolor=#bedaff colspan=2><p align=right><strong>Email</strong></p></td>
<td class=Tiny_Text bgcolor=#bedaff> </td>
<td class=Tiny_Text bgcolor=#bedaff colspan=2><input class=Form_Text_box id=Doctor_email size=33 name=Doctor_email /></td>
<td class=Tiny_Text width=75 bgcolor=#bedaff> </td>
<td class=Tiny_Text bgcolor=#bedaff> </td>
</tr>
<tr valign=top>
<td class=Tiny_Text colspan=2> </td>
<td class=Tiny_Text> </td>
<td class=Tiny_Text> </td>
<td class=Tiny_Text> </td>
<td class=Tiny_Text> </td>
<td class=Tiny_Text> </td>
</tr>
<tr valign=top>
<td colspan=7 bgcolor="#FF0000" class=Tiny_Text style1>Please select the program you wish your child to join </td>
</tr>
<tr valign=top>
<td class=Tiny_Text colspan=2> </td>
<td class=Tiny_Text> </td>
<td colspan="3" class=Tiny_Text><p>Program
<select name="Program" size="1" id="Program">
<option value="Mini Gan" selected="selected">Mini Gan</option>
<option value="Upper Camp">Upper Camp</option>
<option value="CIT (counselor in training) ">CIT (counselor in training) </option>
<option value="Massadah Boys Sports & Adventure Program ">Massadah Boys Sports & Adventure Program </option>
</select>
$
<input name="Program_Amount" type="text" id="Program_Amount" value="" size="10" />
</p>
<label></label></td>
<td class=Tiny_Text> </td>
</tr>
<tr>
<td class=White_Text bgcolor=#339900 colspan=7 height=25><strong><font color=#ffffff size=2>Please indicate number of sessions your child will attend camp:</font></strong></td>
</tr>
<tr>
<td width="77" bgcolor=#bedaff> </td>
<td bgcolor=#bedaff colspan=6><select name=Number_of_Sessions size=1 class=Regular_Text id=Number_of_Sessions tabindex=1>
<option value="Full Season" selected>Full Season</option>
<option value="1 Session">1 Session</option>
<option value="2 Sessions">2 Sessions</option>
<option value="3 Sessions">3 Sessions</option>
<option value="4 Sessions">4 Sessions</option>
<option value="5 Sessions">5 Sessions</option>
<option value="6 Sessions">6 Sessions</option>
</select>
$
<label></label>
<input name="Session_Amount" type="text" id="Session_Amount" size="10" />
<label></label></td>
</tr>
<tr>
<td> </td>
<td colspan=2> </td>
<td colspan=4> </td>
</tr>
<tr>
<td class=White_Text bgcolor=#990000 colspan=7><strong><font color=#ffffff size=2>IMPORTANT</font></strong></td>
</tr>
<tr>
<td bgcolor=#ffffff><div align=right>
<div align=right><font size=1><span class=Regular_Text><font size=1>•</font></span></font></div>
</div></td>
<td class=Regular_Text bgcolor=#ffffff colspan=6>All forms must be completed and submitted before your child begins camp.</td>
</tr>
<tr>
<td bgcolor=#bedaff><div align=right>
<div align=right><font size=1><span class=Regular_Text><font size=1>•</font></span></font></div>
</div></td>
<td class=Regular_Text bgcolor=#bedaff colspan=6><p>I will be paying $
<input name="Total" type="text" id="Total" size="10" />
by:
<input type=radio value=check name=payment />
Check
<input type=radio value=mastercard name=payment />
Mastercard
<input type=radio value=visa name=payment />
Visa
<label></label>
</p>
</td>
</tr>
<tr>
<td valign=top bgcolor=#ffffff><div class=regular_text align=right><strong>
<input id=Agreement type=checkbox value=yes name=Agreement />
</strong></div></td>
<td class=Regular_Text bgcolor=#ffffff colspan=6>I have read the camp brochure and application form and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.</td>
</tr>
<tr>
<td> </td>
<td class=Regular_Text colspan=6> </td>
</tr>
<tr>
<td bgcolor=#bedaff> </td>
<td class=Regular_Text bgcolor=#bedaff colspan=6><strong>Date of Application:
<input name=DateApplication class=Form_Text_box id=Date tabindex=0 required="false" />
</strong></td>
</tr>
</tbody>
</table>
<style type="text/css">
<!--
.style1 {color: #FFFFFF}
-->
</style>
<P><SPAN class=Headline>Online Registration!</SPAN></P>
<P><SPAN class=Regular_Text>Please fill out the form below carefully. When you press submit, this form will be sent to our administration office.</SPAN></P>
<P><SPAN class=Small_Text><STRONG>Note: Please use a separate form for each child.</STRONG></SPAN></P>
<table width=506 border=0 align="center" cellpadding=3 cellspacing=0 bgcolor=#ffffff class=text>
<tbody>
<tr bgcolor=#660099>
<td class=White_Text colspan=7 height=25><strong><font color=#ffffff size=2>Camper/Parent Information</font></strong></td>
</tr>
<tr valign=bottom>
<td colspan=2><div class=regular_text align=right><strong>Name</strong></div></td>
<td width=1> </td>
<td width=112><font class=Tiny_text>
<input name=First_name class=Form_Text_box id=First_Name tabindex=0 value="First " size=15 required="false" />
</font></td>
<td width=150><input name=Middle_Name class=Form_Text_box id=Middle_Name value="Middle" size=15 /></td>
<td width=75><font class=Tiny_text>
<input name=Last_Name class=Form_Text_box id=Last_Name value="Last " size=15 />
</font></td>
<td width=86> </td>
</tr>
<tr valign=bottom>
<td bgcolor=#bedaff colspan=2><div class=regular_text align=right><strong>Address</strong></div></td>
<td bgcolor=#bedaff> </td>
<td bgcolor=#bedaff><input name=Street class=Form_Text_box id=Street value="Street " /></td>
<td width=150 bgcolor=#bedaff><input name=City class=Form_Text_box id=City value="City" /></td>
<td width=75 bgcolor=#bedaff><select name="State" size="1" id='st'>
<option value="Choose State" selected>Choose State</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="VI">Virgin Islands</option>
<option value="AS">American Samoa</option>
<option value="GU">Guam</option>
</select></td>
<td bgcolor=#bedaff><input name=Zip class=Form_Text_box id=Zip value="Zip" size=7 maxlength="5" /></td>
</tr>
<tr>
<td colspan=2><div class=regular_text align=right><strong>Date of Birth</strong></div></td>
<td> </td>
<td><select class=Regular_Text id=Date_Of_Birth_Month tabindex=1 size=1 name=Date_Of_Birth_Month>
<option value="Select Month">Select Month</option>
<option value="January">January</option>
<option value="February">February</option>
<option value=March>March</option>
<option value=April>April</option>
<option value=May>May</option>
<option value=June>June</option>
<option value=July>July</option>
<option value=August>August</option>
<option value="September">September</option>
<option value="October">October</option>
<option value="November">November</option>
<option value=December>December</option>
</select></td>
<td width=150><select class=Regular_Text id=Date_Of_Birth_Day tabindex=1 size=1 name=Date_Of_Birth_Day>
<option value="Select Date" selected>Select Date</option>
<option value=01>01</option>
<option value=02>02</option>
<option value=03>03</option>
<option value=04>04</option>
<option value=05>05</option>
<option value=06>06</option>
<option value=07>07</option>
<option value=08>08</option>
<option value=09>09</option>
<option value=10>10</option>
<option value=11>11</option>
<option value=12>12</option>
<option value=13>13</option>
<option value=14>14</option>
<option value=15>15</option>
<option value=16>16</option>
<option value=17>17</option>
<option value=18>18</option>
<option value=19>19</option>
<option value=20>20</option>
<option value=21>21</option>
<option value=22>22</option>
<option value=23>23</option>
<option value=24>24</option>
<option value=25>25</option>
<option value=26>26</option>
<option value=27>27</option>
<option value=28>28</option>
<option value=29>29</option>
<option value=30>30</option>
<option value=31>31</option>
</select></td>
<td width=75><select class=Regular_Text id=Date_Of_Birth_Year tabindex=1 size=1 name=Date_Of_Birth_Year>
<option value="Select Year" selected>Select Year</option>
<option value=2003>2003</option>
<option value=2002>2002</option>
<option value=2001>2001</option>
<option value=2000>2000</option>
<option value=1999>1999</option>
<option value=1998>1998</option>
<option value=1997>1997</option>
<option value=1996>1996</option>
<option value=1995>1995</option>
<option value=1994>1994</option>
<option value=1993>1993</option>
<option value=1992>1992</option>
<option value=1991>1991</option>
<option value=1990>1990</option>
<option value=1989>1989</option>
<option value=1988>1988</option>
</select></td>
<td> </td>
</tr>
<tr>
<td bgcolor=#bedaff colspan=2><div class=regular_text align=right><strong>Contact Info</strong></div></td>
<td bgcolor=#bedaff> </td>
<td bgcolor=#bedaff><font class=Tiny_text>Phone <br />
</font>
<input class=Form_Text_box id=Phone size=19 name=Phone /></td>
<td width=150 bgcolor=#bedaff colspan=2><font class=Tiny_text>Email <br />
</font>
<input class=Form_Text_box id=Email size=32 name=Email /></td>
<td bgcolor=#bedaff> </td>
</tr>
<tr>
<td colspan=2><div class=regular_text align=right><strong>Schools</strong></div></td>
<td> </td>
<td><font class=Tiny_text>School <br />
</font>
<input class=Form_Text_box id=School size=15 name=School /></td>
<td width=150><font class=Tiny_text>Hebrew School</font>
<input class=Form_Text_box id=Hebrew_School name=Hebrew_School /></td>
<td class=Regular_Text colspan=2><strong class=Tiny_Text style="FONT-WEIGHT: 400">Entering Grade: <br />
</strong>
<input class=Form_Text_box id=Entering_Grade size=10 name=Entering_Grade /></td>
</tr>
<tr>
<td bgcolor=#bedaff colspan=2><div class=regular_text align=right><strong>Child's Mother</strong></div></td>
<td bgcolor=#bedaff> </td>
<td bgcolor=#bedaff><font class=Tiny_text>Mother's Name <br />
</font>
<input class=Form_Text_box id=Mother_Name size=12 name=Mother_Name /></td>
<td width=150 bgcolor=#bedaff><font class=Tiny_text>Hebrew Name</font>
<input class=Form_Text_box id=Mother_Hebrew_Name size=15 name=Mother_Hebrew_Name /></td>
<td width=75 bgcolor=#bedaff><font class=Tiny_text>Work Phone</font>
<input class=Form_Text_box id=Mother_W_Phone size=10 name=Mother_W_Phone /></td>
<td bgcolor=#bedaff><font class=Tiny_text>Cell <br />
</font>
<input class=Form_Text_box id=Mother_Cell_Phone size=10 name=Mother_Cell_Phone /></td>
</tr>
<tr>
<td colspan=2><div class=regular_text align=right><strong>Child's Father</strong></div></td>
<td> </td>
<td><font class=Tiny_text>Father's Name <br />
</font>
<input class=Form_Text_box id=Father_Name size=12 name=Father_Name /></td>
<td width=150><font class=Tiny_text>Hebrew Name</font>
<input class=Form_Text_box id=Father_Hebrew_Name size=15 name=Father_Hebrew_Name /></td>
<td width=75><font class=Tiny_text>Work Phone</font>
<input class=Form_Text_box id=Father_W_Phone size=10 name=Father_W_Phone /></td>
<td><font class=Tiny_text>Cell <br />
</font>
<input class=Form_Text_box id=Father_Cell_Phone size=10 name=Father_Cell_Phone /></td>
</tr>
<tr>
<td bgcolor=#bedaff colspan=2><div class=regular_text align=right><strong>Emergency Contact Info</strong></div></td>
<td bgcolor=#bedaff> </td>
<td valign=bottom bgcolor=#bedaff><font class=Tiny_text>Name <br />
</font>
<input class=Form_Text_box id=Emergency_Name size=12 name=Emergency_Name /></td>
<td valign=bottom width=150 bgcolor=#bedaff><font class=Tiny_text>Phone</font>
<input class=Form_Text_box id=Emergency_Phone size=15 name=Emergency_Phone /></td>
<td valign=bottom width=75 bgcolor=#bedaff><font class=Tiny_text>Relationship</font>
<input class=Form_Text_box id=Emergency_Relationship size=15 name=Emergency_Relationship /></td>
<td valign=bottom bgcolor=#bedaff> </td>
</tr>
<tr>
<td colspan=2><div class=regular_text align=right><strong>Pediatrician</strong></div></td>
<td> </td>
<td><font class=Tiny_text>Name <br />
</font>
<input class=Form_Text_box id=Doctor_Name size=12 name=Doctor_Name /></td>
<td width=150><font class=Tiny_text>Phone</font>
<input class=Form_Text_box id=Doctor_Phone size=15 name=Doctor_Phone /></td>
<td width=75> </td>
<td> </td>
</tr>
<tr valign=top>
<td class=Regular_Text bgcolor=#bedaff colspan=2><p align=right><strong>Email</strong></p></td>
<td class=Tiny_Text bgcolor=#bedaff> </td>
<td class=Tiny_Text bgcolor=#bedaff colspan=2><input class=Form_Text_box id=Doctor_email size=33 name=Doctor_email /></td>
<td class=Tiny_Text width=75 bgcolor=#bedaff> </td>
<td class=Tiny_Text bgcolor=#bedaff> </td>
</tr>
<tr valign=top>
<td class=Tiny_Text colspan=2> </td>
<td class=Tiny_Text> </td>
<td class=Tiny_Text> </td>
<td class=Tiny_Text> </td>
<td class=Tiny_Text> </td>
<td class=Tiny_Text> </td>
</tr>
<tr valign=top>
<td colspan=7 bgcolor="#FF0000" class=Tiny_Text style1>Please select the program you wish your child to join </td>
</tr>
<tr valign=top>
<td class=Tiny_Text colspan=2> </td>
<td class=Tiny_Text> </td>
<td colspan="3" class=Tiny_Text><p>Program
<select name="Program" size="1" id="Program">
<option value="Mini Gan" selected="selected">Mini Gan</option>
<option value="Upper Camp">Upper Camp</option>
<option value="CIT (counselor in training) ">CIT (counselor in training) </option>
<option value="Massadah Boys Sports & Adventure Program ">Massadah Boys Sports & Adventure Program </option>
</select>
$
<input name="Program_Amount" type="text" id="Program_Amount" value="" size="10" />
</p>
<label></label></td>
<td class=Tiny_Text> </td>
</tr>
<tr>
<td class=White_Text bgcolor=#339900 colspan=7 height=25><strong><font color=#ffffff size=2>Please indicate number of sessions your child will attend camp:</font></strong></td>
</tr>
<tr>
<td width="77" bgcolor=#bedaff> </td>
<td bgcolor=#bedaff colspan=6><select name=Number_of_Sessions size=1 class=Regular_Text id=Number_of_Sessions tabindex=1>
<option value="Full Season" selected>Full Season</option>
<option value="1 Session">1 Session</option>
<option value="2 Sessions">2 Sessions</option>
<option value="3 Sessions">3 Sessions</option>
<option value="4 Sessions">4 Sessions</option>
<option value="5 Sessions">5 Sessions</option>
<option value="6 Sessions">6 Sessions</option>
</select>
$
<label></label>
<input name="Session_Amount" type="text" id="Session_Amount" size="10" />
<label></label></td>
</tr>
<tr>
<td> </td>
<td colspan=2> </td>
<td colspan=4> </td>
</tr>
<tr>
<td class=White_Text bgcolor=#990000 colspan=7><strong><font color=#ffffff size=2>IMPORTANT</font></strong></td>
</tr>
<tr>
<td bgcolor=#ffffff><div align=right>
<div align=right><font size=1><span class=Regular_Text><font size=1>•</font></span></font></div>
</div></td>
<td class=Regular_Text bgcolor=#ffffff colspan=6>All forms must be completed and submitted before your child begins camp.</td>
</tr>
<tr>
<td bgcolor=#bedaff><div align=right>
<div align=right><font size=1><span class=Regular_Text><font size=1>•</font></span></font></div>
</div></td>
<td class=Regular_Text bgcolor=#bedaff colspan=6><p>I will be paying $
<input name="Total" type="text" id="Total" size="10" />
by:
<input type=radio value=check name=payment />
Check
<input type=radio value=mastercard name=payment />
Mastercard
<input type=radio value=visa name=payment />
Visa
<label></label>
</p>
</td>
</tr>
<tr>
<td valign=top bgcolor=#ffffff><div class=regular_text align=right><strong>
<input id=Agreement type=checkbox value=yes name=Agreement />
</strong></div></td>
<td class=Regular_Text bgcolor=#ffffff colspan=6>I have read the camp brochure and application form and agree to the terms stated. I give my child permission to attend all trips, and receive medical care in the case of emergency.</td>
</tr>
<tr>
<td> </td>
<td class=Regular_Text colspan=6> </td>
</tr>
<tr>
<td bgcolor=#bedaff> </td>
<td class=Regular_Text bgcolor=#bedaff colspan=6><strong>Date of Application:
<input name=DateApplication class=Form_Text_box id=Date tabindex=0 required="false" />
</strong></td>
</tr>
</tbody>
</table>