Please complete the registration form below for your child to be part of our Summer Camp Program. 

Child's Name *
Child's Name
Child's Date of Birth
Child's Date of Birth
Parent's Name *
Parent's Name
Address *
Address
Please write none if your child does NOT have any known allergies.
Primary Phone Number
Primary Phone Number
Secondary Phone Number
Secondary Phone Number
Checkbox on the weeks your child will be attending
Expiration Date *
Expiration Date
Please indicate the 1st day of the month (for day)
This 3-digit number is located on the back of the card.