Mom's Day Out Summer Camp
Child's Name *
Your answer
Birthdate *
Your answer
Please list any food allergies, intolerances, or special needs we should know about.
Your answer
Child's Name (2)
Your answer
Birthdate
Your answer
Please list any food allergies, intolerances, or special needs we should know about.
Your answer
Child's Name (3)
Your answer
Birthdate
Your answer
Please list any food allergies, intolerances, or special needs we should know about.
Your answer
Which summer camp session(s) are you registering for?
Mom's Name *
Your answer
Phone number *
Your answer
Email *
Your answer
Dad's Name *
Your answer
Phone number *
Your answer
Email
Your answer
Person(s) who will be dropping off and picking up. Please list name and phone number. *
Your answer
Session Fees
Each session is $90 for the first child. Siblings each receive a $10 discount.


Once I receive your registration form I will contact you via email to set up payment. I wish I were awesome enough to be able to accept credit cards. Unfortunately, being a small, home-based business we're going to have to be content with old school checks or the more hip, and immediate, Venmo or PayPal.

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