DRIDON SUMMER CAMP 2015 APPLICATION

To be completed by Parent / Guardian. All information provided will be treated with the strictest confidence and shall not be shared with any third-party outside of our organization.

    Student Information

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    Parent / Guardian / Caregiver Information

    Caregiver must have parent's authorization to complete this form.
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    Enrollment Sessions

    3 Semi Days
    4 Semi Days
    5 Semi Days
    3 Full Days
    4 Full Days
    5 Full Days
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    Areas of Emphasis

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    A PORTRAIT OF YOUR CHILD

    At best, describe your child.
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    TRANSPORTATION

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    Early Drop Off / Late Pickup

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    Special Needs (medical or medical related)

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    In Cases of Emergency

    Note: In all cases of serious emergencies, our first response is to call 911.*
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    Referrals & Discounts

    Referring a friend, family or neighbor who enrolls a child with us can earn you discounts. If you have referred someone or you are thinking of someone whose child can benefit from our services, feel free to include that person's name and phone number.
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    Source Tracking

    Your response to this question allows us to serve more and more under-served communities. Help us to help others.
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