Please fill out a separate form for each child. Register by April 15, and save!
Please fill out the form below, indicating how you will pay for the session, and press the Submit button. Your registration is not confirmed until we receive payment. We will call you for credit card or EFT payment.
CHILD'S LAST NAME:
CHILD'S FIRST NAME:
MIDDLE INITIAL:
AGE:
DATE OF BIRTH:
PARENT/GUARDIAN LAST NAME:
PARENT/GUARDIAN FIRST NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
PHONE NO.:
EMAIL:
RELATIONSHIP TO CHILD:
METHOD OF PAYMENT: (Cash, Check, Gift Card, Credit Card, Online)
HOW DID YOU HEAR ABOUT THIS PROGRAM?:
CAMP REGISTRATION
Program Name/Check Sessions
Dates/Times
Fee if register by April 15
(Check box that applies)
Dates:
TOTAL:
(Please add up all camp and childcare totals and enter the amount here. Discounts will be taken prior to contacting you for payment.)
Dates:
June 14 - Aug. 6, 8:30 am - 12 noon
Total Days:
Total Days:
Total Amount:
Total Amount:
June 14 - July 9, 8:30 am - 12 noon
July 12 - Aug. 6, 8:30 am - 12 noon
8:30 am - 12 noon
8:30 am - 12 noon
7:30 -8:30 am
$2.50 per session
Dates:
12:30 - 2 pm
$2.50 per session
Dates:
(If you elected to pay online, you will be able to do so after you submit this form
