Email address *
Student Information
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Current class (grade level): *
Your answer
School Name *
T-shirt Size *
Program Options
Full Day: 9:00 - 4:00 Half Day: 9:00 - 12:30 or 12:30 - 4:00
Weeks of Summer Camp
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Language Options
*Only for 5 years old and up *
Parent Information
Primary Contact Person
First & Last Name *
Your answer
Phone Number *
Your answer
Additional Contact Information
Name and relationship *
Your answer
Phone Number *
Your answer
Additional Services @ Cost
Transportation *
Pick Up Address
Your answer
Lunch & Snack Program *
Dietary Restrictions & Allergies
Select dietary restrictions, if any *
Allergies
Your answer
Field Trips
I give permission for my child to attend all weekly Field Trips
Discounts
15 % Tuition Discount in case of registration for 6 weeks
15 % Tuition Discount for second child (siblings only)
Medical Info
In case of any health conditions or serious allergies, please notify the administration/health office during the registration process.
A copy of your responses will be emailed to the address you provided.
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