KidsSTREAM Summer Camp 2019 Interest Form
CAMP IS CURRENTLY FULL. We are only accepting children that will be placed on the waiting list until June 1, 2019. Afterwards, the registration will be closed.

Please make sure to answer all the questions. Once you have submitted your information, please be on the look out for an email to confirm your interest in our Summer Program and a packet to complete.

NOTE: Submitting your registration packet and completing this interest form does not guarantee a spot in the camp. All forms must be completed along with the appropriate funds provided. Registration and application fee is required when submitting the application.
Parent/Guardian Information
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone Number
Your answer
Cell Phone Number *
Your answer
Email Address *
Your answer
The best way to contact me is *
Are Any of the Parents Currently Serving in the Military? *
How Many Children Are You Signing Up for the Summer Program? *
What are the age(s) of the child/children?
Your answer
Special Health Conditions
Your answer
Which week you wish your child(ren) to enroll? *
Select all that applies.
Required
Will your child(ren) be in before or after care?
Please select one
Are any of your children have a 504, IFSP, Gifted/Talented, or an IEP plan? *
If yes, which special services do they have?
Check all that applies
Any additional comments or questions.
Your answer
Please Make Sure to Review Your Information Before Clicking the Submit Button
By submitting the interest form, you acknowledge that the information is correct. If any information is incorrect and not brought up to the organization immediately may result in the cancellation of the registration with no refund returned.
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