2017 CFK Application - Lycoming College for Kids & Teens
Please fill out this form to register your child(ren) for the 2017 annual Lycoming College for Kids & Teens summer program. Payment is made separately, and all classes are filled on a first-come, first-served basis. Children are enrolled in their first choice class, when possible. Class size is limited and classes close quickly, so be sure you select a second choice.

Classes are held July 17-21, 2017 at Lycoming College.

You will receive an automatic email confirmation of this form submission, but that does not mean the class chosen is available. You will receive a second, complete notification from Debbie Smith of Lycoming College, confirming that your child has been enrolled in the program and in which classes. If the class requires a fee, it has a * next to it.

Last Name of Child:
Your answer
First Name of Child:
Your answer
Street Address:
Your answer
City:
Your answer
State
Your answer
Zipcode
Your answer
Parent 1 Name:
Your answer
Parent 1 Email: (This is the person receiving the form notification)
Your answer
Parent 1 Phone (Mobile)
If one phone number is used for Home, Work and Mobile, please enter it again
Your answer
Parent 1 Phone (Home)
If one phone number is used for Home, Work and Mobile, please enter it again
Your answer
Parent 1 Phone (Work)
If one phone number is used for Home, Work and Mobile, please enter it again
Your answer
Parent 2 Name:
Your answer
Parent 2 Email:
Your answer
Parent 2 Phone (Mobile)
Your answer
Parent 2 Phone (Home)
Your answer
Parent 2 Phone (Work)
Your answer
Child's School:
Your answer
Grade Completed as of June, 2016:
Your answer
Emergency Contact Name and Phone Number:
Your answer
Child’s T-shirt size:
First Period -- First Class Choice:
Choose your child's first choice of class for First Period (9 a.m.-Noon)
First Period -- Second Class Choice (If first is not available):
Choose your child's second choice of class for First Period (9 a.m.-Noon)
Second Period -- First Class Choice:
Choose your child's first choice of class for Second Period (Noon-4 p.m.)
Second Period -- Second Class Choice (If first is not available):
Choose your child's second choice of class for Second Period (Noon-4 p.m.)
Before Care & After Care
My child will need Before or After Care
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