2018 CFK Application - Lycoming College for Kids & Teens
Please fill out this form to register your child(ren) for the 2018 annual Lycoming College for Kids & Teens summer program. If you are enrolling more than one child, please use the form for one enrollment only. After you have completed the form and submitted it for the first child, refresh the page (Shift and Refresh) for a new, blank application form.

Payment is made separately, and all classes are filled on a first-come, first-served basis. Children are enrolled in their first choice class, when possible. Class size is limited and classes close quickly, so be sure you select a second choice.

Classes are held July 16-20, 2018 at Lycoming College.

You will receive an automatic email confirmation of this form submission, but that does not mean the class chosen is available. You will receive a second, complete notification from Debbie Smith of Lycoming College, confirming that your child has been enrolled in the program and in which classes. If the class requires a fee, it has a * next to it.

Last Name of Child: *
Your answer
First Name of Child: *
Your answer
Street Address: *
Your answer
City: *
Your answer
State *
Your answer
Zipcode *
Your answer
Parent 1 Name: (This is the person registering the child) *
Your answer
Parent 1 Email: (This is the person receiving the form notification) *
Your answer
Parent 1 Email: (Confirmation - Type Twice) *
Your answer
Parent 1 Phone (Best Contact -- Mobile) *
If one phone number is used for Home, Work and Mobile, please enter it again
Your answer
Parent 1 Phone (Second Best Contact) *
If one phone number is used for Home, Work and Mobile, please enter it again
Your answer
Parent 2 Name: (If you wish; good backup)
Your answer
Parent 2 Email:
Your answer
Parent 2 Phone (Best Contact Phone)
Your answer
Parent 2 Phone (Second Best Contact)
Your answer
Parent 2 Phone (Work)
Your answer
Parent 2 Phone (Work)
Your answer
Emergency Contact Name and Phone Number: *
Your answer
Child's School: *
Your answer
Grade Completed as of June, 2017: *
Your answer
Child’s T-shirt size: *
First Period -- Class Choice:
Choose your child's first choice of class for First Period (9 a.m.-Noon)
Second Period -- Class Choice:
Choose your child's first choice of class for Second Period (Noon-4 p.m.)
College for Teens (Full Day, Grades 9-12 Only)
Before Care & After Care
My child will need Before or After Care
Lunch
My child will do one of the following for lunch
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