This is a non-refundable Summer Camp Fee per child for all families at the time of registration. This form is for online registration only. After completing this form, you will be directed to pay the Summer Camp Fee by credit card. Our online registration is only set up to take credit cards. If you would like to pay your Summer Camp Fee by check or money order, you will need to fill out our mail-in registration form and mail it with your Summer Camp Fee payment. Registration will be taken as a first come, first serve basis.









First Name
Last Name
Child’s Birth Date
Child’s Age
Child’s Gender
MF
Child’s Race
Child’s T-Shirt Size
Grade Completed for ’17/’18 school yr
Parent First Name
Parent Last Name
Parent First Name
Parent Last Name
Address
Address 2
City
ZIP
Email
Phone
How did you hear about us?

Please Elaborate:
Has this child in the past received services from any part of our agency?
NoYes
Does your child have an IEP?
NoYes
Are you eligible for a staff discount?
NoYes

Are you eligible for the sibling rate?
NoYes

Location

*** You must select a minimum of 3 dates per week that you would like your child to attend ***

June 4-8

June 11-15

June 18-22

June 25-29

July 2-6

July 9-13

July 16-20

July 23-27

July30-August 3

August 6-10

August 13-15

Payment Category