Child's Name *

First Name

Last Name

Cell Phone *

(###)

###

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Home Telephone

(###)

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Please let us know if you are interested in Before and/or After Care

Yes (please select your preference below)

No

Please select all weeks your child will attend: *

Week 1 (July 8 - 12)

Week 2 (July 15 - 19)

Week 3 (July 22 - 26)

Week 4 (July 29 - Aug 2)

Week 5 (August 5 - 9)

Week 6 (August 12 - 16)

Week 7 (August 19 - 23)