Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Name *

First Name

Last Name

Cell *

(###)

###

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Name *

First Name

Last Name

Work Phone *

(###)

###

####

Cell Phone

(###)

###

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Full-Day *

$175/wk, $550 for 4 weeks. Select all that apply.

Week 1

Week 2

Week 3

Week 4

After-Care

4:00 PM – 5:30 PM, $30/wk

Week 1

Week 2

Week 3

Week 4

Before-Care

7:45 AM - 8:30 AM, $10/wk

Week 1

Week 2

Week 3

Week 4

Camp Fee *

A $100 deposit, due May 31st, is required to reserve your child's spot. This fee will be applied towards the remaining camp fees, due June 15th.

Yes, I understand that a deposit of $100 is due before May 31st to reserve my child's spot. I will pay this fee before the due date, and pay the remaining camp fees by June 15th via cash, check, or PayPal.