Summer Registration
Parent Information
First Name
Last Name
Email
Phone
Child Information
Child's First Name
Child's Last Name
Child's Gender
Boy
Girl
Not Specified
Child's Birthday
Child's First Name
Child's Last Name
Child's Gender
Boy
Girl
Not Specified
Child's Birthday
Add Additional Child
Summer Camp Runs From June 3- August 21
Desired Start Date
Desired End Date
How many days per week?( 3 day minimum)
3
4
5
Desired hours of care ( available 6am-6pm)
Additional Information
Form of Payment
State Funded
Private Pay
Message
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