CWA After-school and Summer Camp Application
Application for enrollment into the Christine Avery Learning Center, Inc. Please include all of the information listed. If you have additional children, you can include up to three kids on one application. If you have more than three kids, please complete separate applications
Email address *
Last Name (Child 1) *
Your answer
First Name (Child 1) *
Your answer
Middle Name (Child 1)
Your answer
Nickname (Child 1)
Your answer
Date of Birth (Child 1) *
MM
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DD
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YYYY
Age (Child 1) *
Your answer
Gender (Child 1) *
Last Name (Child 2)
Your answer
First Name (Child 2)
Your answer
Middle Name (Child 2)
Your answer
Nickname (Child 2)
Your answer
Date of Birth (Child 2)
MM
/
DD
/
YYYY
Age (Child 2)
Your answer
Gender (Child 2)
Last Name (Child 3)
Your answer
First Name (Child 3)
Your answer
Middle Name (Child 3)
Your answer
Nickname (Child 3)
Your answer
Date of Birth (Child 3)
MM
/
DD
/
YYYY
Age (Child 3)
Your answer
Gender (Child 3)
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