Email address *
Student Information
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Current class (grade level): *
Your answer
School Name *
Program Options
___________________
Week 1
Week 2
Week 3
Week 4
Week 5
Week 6
Parent/Guardian Information
First & Last Name *
Your answer
Phone Number *
Your answer
Additional Services
Transportation *
Pick Up Address
Your answer
Lunch & Snack Program: $25/week *
Dietary Restrictions & Allergies
Select dietary restrictions, if any *
Allergies:
Your answer
Discounts
15 % Tuition Discount in case of registration for 6 weeks
15 % Tuition Discount for second child (siblings only)
Medical Info
In case of any health conditions or serious allergies, please notify the administration/health office during the registration process.
A copy of your responses will be emailed to the address you provided.
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