Session 1 (June 29 - July 22) *

Pre-K Readiness - 3 Day - $250.00

Opting Out of Session 1

Session 2 (August 3 - August 26) *

Little Tykes - 1 Day - $100.00

Big Kids - 2 Day - $200.00

Preschool - 2 Day - $200.00

Preschool - 3 Day - $250.00

Pre-K Readiness - 3 Day - $250.00

School Age - 3 Day - $250.00

Opting Out of Session 2

Name of Child *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent / Guardian Name *

First Name

Last Name

Phone Number *

(###)

###

####

Parent / Guardian Name

First Name

Last Name

Phone Number

(###)

###

####

Emergency Contact #1 *

List below the names of 2 people we can contact if a parent/guardian cannot be reached.

First Name

Last Name

Phone Number *

(###)

###

####

Is this person authorized to pick up my child? *

Yes

No

Emergency Contact #2 *

First Name

Last Name

Phone Number *

(###)

###

####

Is this person authorized to pick up my child? *

Yes

No

Social Media Policy *

I DO give permission for my child's photo/video to be shared via Facebook, Website, Instagram, Newspaper or TV.

I DO NOT give permission for my child's photo/video to be shared via Facebook, Website, Instagram, Newspaper or TV.