Summer Camp Registration
Please submit payment (cash or check) to the Noah's Little Ark tuition box. Contact Kim (Kimberly.Zenyuch@gmail.com) with questions or concerns. Thanks!
Email address *
Child's Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Address *
Your answer
Parent 1 - Name and Phone Number *
Your answer
Parent 2 - Name and Phone Number *
Your answer
Allergies/Restrictions/Disabilities
Your answer
Emergency Contacts (please list 2) and phone numbers *
Your answer
Additional person(s) permitted to pick up *
Your answer
Will your child attend Mad Scientist (June 19-22) - $50 *
Will your child attend Water World (July 17-20) - $50 *
Will your child attend Exploring the Great Outdoors (Aug 7-10) - $50 *
A copy of your responses will be emailed to the address you provided.
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