Register

CHILD NAME *

CHILD BIRTHDATE (/MM/DD/YYYY) *

Please indicate your choice of program.*

Please indicate choice of Full days, Mornings or Afternoons.*


Select the weeks attending March Break

Select the weeks attending Summer Camp

*4 day week due to holiday


PARENT/GUARDIAN NAME*

EMAIL*

PHONE*

ADDRESS*

EMERGENCY CONTACT NAME *

EMERGENCY CONTACT PHONE NUMBER *


IF DROP IN INDICATE DATES

BEFORE/AFTER CARE REQUESTED - DATES AND TIME

MEDICAL, ALLERGIES AND OTHER INFORMATION WE MAY NEED


Waiver of Liability | Photography Waiver

I HAVE READ AND AGREE WITH THE RELEASE & WAIVER OF LIABILITY*
I ALSO AGREE TO THE PHOTOGRAPHY WAIVER RELEASE