Summer Camp Registrtion Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Preferred Child Care Center LocationSummer CampPreferred Start DateDateTimeHours Required DailyMornings (Half Day)Afternoons (Half Day)Full DayDays RequiredMondayTuesdayWednesdayThursdayFridaySaturdayParent Account DetailsParent/Guardian Name *FirstLastDoes the child live with you full time?YesNoPlease detail the living situation:Email *Phone *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent Photo * Click or drag a file to this area to upload. Emergency Contact Name *FirstLastEmergency Contact Phone *Student DetailsName *FirstLastDate of Birth *GenderFemaleMaleStudent's Doctor's Name *FirstLastStudent Health Insurance CompanyStudent's Doctor's Phone *Is anyone besides you allowed to pick up your child?NoYesPlease list who can pick up your child:Photos of those allowed to pick up your child: Click or drag a file to this area to upload. Please let us know about any behavioral concerns:Please let us know about any medical concerns:Please let us know about any allergies:Submit
