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SUMMER PROGRAM 2025
Sign up for the Crystal Lake Teen Center's Summer Program!
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MM
/
DD
/
YYYY
Your answer
What Grade Are You Going Into?
*
Your answer
Full Summer or Select Weeks?
*
Full Summer
Select Weeks
If Select Weeks, then which weeks are we most interested in
Week 1 (6/2 -6/6)
Week 2 (6/9 - 6/13)
Week 3 (6/16 - 6/20)
Week 4 (6/23 - 6/27)
Week 5 (6/30 - 7/4)
Week 6 (7/7 - 7/11)
Week 7 (7/14 - 7/18)
Week 8 (7/21 - 7/25)
Week 9 (7/28 - 8/1)
Week 10 (8/4 - 8/8)
T-Shirt Size
XS
S
M
L
XL
XXL
Clear selection
Emergency Contact Name
Your answer
Emergency Contact Phone Number
Your answer
Allergies?
Your answer
Interested in Financial Assistance?
Yes
No
Clear selection
Are you currently a Break Member? If not, please fill out our online Registration Form at clbreak.com in addition to this form
Yes
No
Clear selection
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