2017 Youth Summer Camp Registration Form
Thank you for your interest in CCC's 2017 Youth Summer Camp! Please complete one registration form per child enrolled in the Youth Summer Camp. This is step 1 of 3 in the registration process.

Registration Process:
1. Complete this online form - "2017 Youth Summer Camp Registration Form"
2. Indicate how you will be paying - weekly, monthly, entire balance. You will be sent an invoice corresponding to the option that you choose along with a Meal Eligibility Form - all enrolled students eating any meals at the center must have one on file, regardless of eligibility.
3. Pay invoice and return Meal Eligibility Form through email or in person.

IMPORTANT: Your child's reservation for any particular week is not confirmed until payment has been received. Reservations are made on a first paid/first reserved basis.

Child's Information
Child's First Name
Your answer
Child's Last Name
Your answer
Child's Middle Initial
Your answer
Child's Date of Birth
MM
/
DD
/
YYYY
Child's Sex
Child's Racial Identity
Child's Home Address
Street Number and Street Name
Your answer
Child's City
Your answer
Child's State, Zip Code
ex: TX, 77036
Your answer
When will your child attend camp?
Check all that apply
Required
If child is attending partial weeks, please indicate which week and days attending in the following box.
Ex. Week 1 - M/T/W
Your answer
Which weeks do you want to sign your child up for the Mandarin Language and Culture Track?
(Additional fee of $50/wk for add-on or $140/wk for language classes only) Leave blank if not applicable
Which weeks do you want to sign your child up for the English as a Second Language (ESL)?
(Additional fee of $60 a week) Leave blank if not applicable
Days in Care
Select all days of the week that your child may possibly attend camp throughout the summer.
Required
Hours in Care
Meals to be served to child at the center
Select all that apply.
Required
Which weeks do you want to sign your child up for transportation FROM Feld Park (next to old MCLIMS campus) to CCC?
Pickup from 7:30am-7:45am daily. (Additional fee of $30/wk round trip)
Which weeks do you want to sign your child up for transportation FROM new MIMS campus to CCC?
Pickup from 7:55am-8:10am daily. (Additional fee of $30/wk round trip)
Which weeks do you want to sign your child up for transportation FROM CCC to Feld Park (next to old MCLIMS campus)?
Drop off from 5:30pm-5:45pm daily. (Additional fee of $30/wk round trip)
Which weeks do you want to sign your child up for transportation FROM CCC to new MIMS campus?
Drop off from 5:55pm-6:10pm daily. (Additional fee of $30/wk round trip)
Child's T-Shirt Size
Does the child have medical insurance or CHIP?
Number of People in Household
Female Head of Household?
Mother/Guardian's Information
Mother/Guardian's First Name Last Name
ex: Jane Smith
Your answer
Mother/Guardian's E-mail Address
Your answer
Mother/Guardian's Cell Phone Number
format: xxx-xxx-xxx
Your answer
Mother/Guardian's Work Phone Number
format: xxx-xxx-xxx
Your answer
Is the child's mother/guardian's address the same or different from the child's address?
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