2018 CFK Extended Care Form
Application for Extended Care
Lycoming College for Kids and Teens July 16-20, 2018
Last Name of Child *
Last Name Only
Your answer
First Name of Child *
First Name Only
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Parent 1 Name *
Your answer
Parent 1 Email *
Your answer
Parent 1 Phone (Mobile) *
Your answer
Parent 1 Phone (Work or Home)
Your answer
Parent 2 Name
Your answer
Parent 2 Phone (Work or Home)
Your answer
Emergency Contact (Name and Phone) *
Your answer
Select Days You'll Need Before Care
Select Days You'll Need After Care
Submit
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