Registration Information
Child’s first name *
Your answer
Child’s last name *
Your answer
Child's birth date *
MM
/
DD
/
YYYY
Gender *
Please choose your preferred dates for Summer Camp. Dates are not confirmed until payment is accepted. Minimum of 2 weeks required, weeks do not have to be consecutive.
Preferred weeks: *
Required
Do you have a preference for Robins or Chick-a-dees? *
1st parent name *
Your answer
1st parent email *
Your answer
1st parent phone *
Your answer
2nd parent name
Your answer
2nd parent email
Your answer
2nd parent phone
Your answer
Home address *
Your answer
Please share the names, relationship and contact information of those who are allowed to pick up your child from Little Leaf at Andrus-on-Hudson
1st contact name
Your answer
1st contact relationship
Your answer
1st contact phone
Your answer
2nd contact name
Your answer
2nd contact relationship
Your answer
2nd contact phone
Your answer
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