Santa Cruz Learning Center Spring Break Camp Registration 2023
Thanks for registering for the SCLC Spring Break Camp!

Location: 2560 Soquel Ave. Suite 201
Santa Cruz, CA 95062
Dates: Tuesday 4/4, Wednesday 4/5, and Thursday 4/6
Times: 9:30am-4pm 
$65 per day (all three days $180, $15 off)

 Inquire with Jennifer with specific questions. 
(734) 620-0660‬

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Student First Name *
Student Last Name *
Student Cell Number (if Applicable)
Student Email Address (if applicable)
Grade Level for the 2023 school year *
School(s) Attending *
Parent/Guardian 1 Full Name *
Guardian 1 Mailing Address *
number and Street, City, Zip
Parent/Guardian 1 Email *
Parent/Guardian 1 Phone # *
Billing address for Parent/Guardian 1 *
Street address, City, State, Zip
Best way to contact Parent/Guardian 1 *
Parent/Guardian 2 Full Name
Guardian 2 Mailing Address
number and Street, City, Zip
Parent/Guardian 2 Email
Parent/Guardian 2 Phone #
Best way to contact Parent/Guardian 2
Has this student been diagnosed with any learning exceptionalities?
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If your child has been diagnosed with a learning exceptionality, please share with us a little about his or her diagnosis. If possible, could you share their diagnosis report with our education team?  Do you have specific tools and/or learning/teaching strategies that have been successful?
Occasionally we take photos/videos during class. Do we have your permission to use photos/videos of your child in our newsletters and/or fliers to promote our classes? *
How did you hear about us? *
Is there anything else that we didn't ask on this form that you think we should know?
You don't have to come to camp all three days.  If you would like, you may come for 1, 2,  or all  of the days that we are offering camp.   *
Please indicate which days you would like to come  (click all that apply)
How do you plan to pay?
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