SPRING BREAK CAMP 2020
Register here for Spring Break Camp 2020

Dates: March 16th -20th, 2020
Location: Kennedy Community Center, 2800 S. D Street, Stockton, CA 95206
Hours: 10 am - 5 pm
Cost: FREE

Let your child be active, have fun and learn during Spring Break. Our FREE 5-day camp is for kids ages 9 - 15. Our campers will spend a week doing activities that are not only fun, but will also help them learn new skills, set and achieve goals, and build self-confidence. Please complete this form to register your child for our Spring Break Camp.

Lunch and snacks are provided!

A 1-day field trip is also included.

SPACE IS LIMITED,!! Registrations will be accepted on a first-come basis. So register now!

Once we receive your information, we will confirm your registration. If you have any questions, please call our office at ( 209) 229-4559.
Email address *
Date of Request
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Youth's First Name *
Your answer
Youth's Last Name *
Your answer
Participant's Age (ages 9-15 only) *
Participant's Birthdate (make sure the year of birth is correct) *
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DD
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YYYY
Home Address *
Your answer
City *
If "Other" City, please list here
Your answer
Zipcode *
Your answer
Contact Phone Number (ie. xxx-xxx-xxxx) *
Your answer
Other Phone Number (ie. xxx-xxx-xxxx)
Your answer
Participant's School Name *
Your answer
Is the Youth currently participating in a Sow A Seed program? (check all that apply) *
Required
Referred by *
Parent/ Guardian Name ( First, Last) *
Your answer
Relationship to Youth *
Parent/Guardian phone number *
Your answer
Parent/ Guardian email address *
Your answer
Emergency Contact Name & phone number *
Your answer
Number in Household *
Housing *
Youth's Sexuality *
Annual Income *
Does Youth Qualify for Free or Reduced Lunch Program at School? *
Source of Income (check all that apply) *
Required
Youth's Ethnicity (check all that apply) *
Required
I give permission for the participant listed above to participate in the Kennedy Community Center Spring Break program. I also waive, release and discharge all claims for personal and property damages arising from my child's participation *
Required
I understand that by registering my child for this program that I am responsible for picking up my child, or arranging for someone to pick up my promptly by 5 pm each day. I am aware that after 2 late pick-ups ( arriving after 5 pm) that my child will be dismissed from the program. *
Required
The following persons have my permission to pick up my child from the program. Please include First and Last name and their phone number ( ex. Joe Blue 209-555-1122)
Your answer
Please list allergies, dietary restrictions, medical conditions, or special accommodations needed for youth.
Your answer
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