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) *
First Name (Child 1) *
Middle Name (Child 1)
Nickname (Child 1)
Date of Birth (Child 1) *
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Age (Child 1) *
Gender (Child 1) *
Last Name (Child 2)
First Name (Child 2)
Middle Name (Child 2)
Nickname (Child 2)
Date of Birth (Child 2)
MM
/
DD
/
YYYY
Age (Child 2)
Gender (Child 2)
Clear selection
Last Name (Child 3)
First Name (Child 3)
Middle Name (Child 3)
Nickname (Child 3)
Date of Birth (Child 3)
MM
/
DD
/
YYYY
Age (Child 3)
Gender (Child 3)
Clear selection
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