SUMMER BREAK @ THE CLUB 2023
Please complete and submit the following information to sign up a student or students for The Club's Summer Program.

- This form must be completed by a parent or legal guardian. If you are enrolling a student on someone else's behalf, please contact us for special instructions before completing this form.

- The Summer Program will operate from June 20 through July 28, weekdays from 9 AM - 5 PM (no programs July 4).

- Students entering grades K - 6 in the 2023-24 school year are welcome to enroll. For those students entering kindergarten in the fall, their fifth birthday must fall on or before August 31, 2023, to enroll. Current fifth graders entering the sixth grade in the fall may enroll.

- At least two emergency contacts are required.

- Once submitted, The Club's staff will review your enrollment and email you with further instructions within two business days.

Questions? Call us at (509) 204-3146 or contact us by email at info@theclubdayton.org.
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Email *
May we use this email address to contact you? *
New regulations require us to have your consent to contact you via email. We will not share your email address with anyone outside of our organization. You may opt out at any time. Additional addresses can be added to The Club's contact list upon request. 
Primary Parent/Guardian Name (First & Last) *
Please provide information for a person who has custody and/or legal guardianship of the enrolled student(s).
Address (Street/PO Box, City, State & Zip) *
Best Contact Phone Number with Area Code *
Phone Number Type *
May we use this number to send updates via text and/or voice message? *
The Club uses a mass messaging service to send important program announcements and updates via text and/or voice message. Your phone number will not be shared with anyone outside of our organization. You may opt out of this service at any time. Additional numbers can be added upon request.
How many students are you enrolling in the summer program? *
All students must reside in the same household. Please submit a separate registration if you are signing up students from different households.
Relationship to student(s) *
Please note that this form must be completed by someone with legal guardianship of the student(s) being enrolled.
Does the member live with this Parent/Guardian? *
Is this Parent/Guardian an emergency contact? *
Is this Parent/Guardian allowed to pick up the member? *
Secondary Parent/Guardian Name (First & Last)
Does the member live with this Parent/Guardian?
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Address, if different (Street/PO Box, City, State & Zip)
Best Contact Phone Number with Area Code
Phone Number Type
Clear selection
Relationship to student(s)
Clear selection
Is the secondary Parent/Guardian an emergency contact?
Clear selection
Is the secondary Parent/Guardian allowed to pick up the member?
Clear selection
Would you like to add an additional emergency contact or authorized pickup person? *
Please note that we will only release students to persons listed on this form without prior authorization. If someone not listed attempts to pick up your student(s), we will call you to verify before releasing them.
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