Summer Camp Registration Form
Complete the form below and Ultra Lanes Massapequa will contact you shortly.
What weeks will your child attend Camp Ultra Lanes? *
you may pick multiple dates
Required
Are you interested in before care or after care for your child?
regular camp hours are 9am to 3pm
Parent's Name *
Your answer
Email Address *
Your answer
Child's Name *
Your answer
Child's Age *
Ages 6-14 only *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Comments/Questions - ask away!
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Where did you see this special promotion? *
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