INTEREST Form

Child First Name: REQUIRED Please fill out this field. Please enter valid data.

Child Last Name: REQUIRED Please fill out this field. Please enter valid data.

Grade Level in Sept 2023 REQUIRED Please fill out this field.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Gender REQUIRED Male Female Please fill out this field.

Select Weeks of Camp:

Week 1: June 19 - 23 $300.00

Week 2: June 26 - 30 $300.00

Week 3: July 5-7 (No Camp July 3rd & 4th) $200.00

Week 4: July 10-14 $300.00

Week 5: July 17-21 $300.00

Week 6: July 24-28 $300.00

Week 7: July 31 - Aug 4 $300.00

Week 8: Aug 7-11 $300.00

Add Morning Care Beginning at 7:30 AM - select weeks: Week 1 - $75 Week 2 - $75 Week 3- $60 Week 4 - $75 Week 5 - $75 Week 6 - $75 Week 7 - $75 Week 8 - $75

Parent/Guardian:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.