Heart and Hands Scholarship Registration
June 24- June 28, 2019
Parent or Guardian Name *
Your answer
Parent or Guardian Cell Phone (permission to text) *
Your answer
Additional Emergency Contact Number *
Your answer
Who Has Permission To Pick Up Your Child? *
Parent or Guardian Mailing Address *
Your answer
Parent or Guardian Email *
Your answer
Name of Child *
Your answer
What name does your child prefer to be called, if different from their given name?
Your answer
What school does your child attend? *
Your answer
Age of Child *
Your answer
Scholarships are only available the week of June 24- June 28th. *
Your answer
Any health or emotional challenges? *
Description of any accommodation needed:
There will be photos taken during the camp for our funder, posting on social media, future flyers and the EYC website. I agree to allow photos of my child to be posted in these forms of media. *
Required
Camp begins at 9:00 a.m. and ends at 12:00 p.m. If dropping off between 8:15 a.m. and 8:45 a.m., a $25 fee will must be paid in full prior to the start of camp. Late pickup between 12:15 p.m. and 12:30 will be subject to an additional $25 fee. A credit card number will need to be left on file to charge for payment at the end of the week. *
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