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Winter Mini-Camp
Parent First Name
Parent Last Name
Email
Cell Phone Number
Child 1 Name
Child 1 Grade/Age
Select Grade/Age
18-24 months
2-3 years
4-5 years (pre-K)
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Please share any allergies or special details our staff should know about Child 1.
Child 2 Name
Child 2 Grade/Age
Select Grade/Age
18-24 months
2-3 years
4-5 years (pre-K)
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Please share any allergies or special details our staff should know about Child 2.
Child 3 Name
Child 3 Grade/Age
Select Grade/Age
18-24 months
2-3 years
4-5 years (pre-K)
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Please share any allergies or special details our staff should know about Child 3.
*
Emergency Contact 1
*
Phone Number
*
Emergency Contact 2
*
Phone Number
Member Fees - $65 per day
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Dec. 21
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Dec. 29
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Dec. 30
Non-Member Fees - $80 per day
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Dec, 21
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Dec. 22
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Dec. 23
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Dec. 28
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Dec. 29
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Dec. 30
Total
Thu, April 15 2021 3 Iyyar 5781