Camper Information

*Last Name

*First Name

*Date of Birth

*Address

*City

*State

*Zip

Country

*Home Phone

Note (including day choices for partial weeks)

Medical Information

Physician Name

Physician Phone

Insurance

Insurance Number

Allergies

Medical Note

Parent Information
Father

Title

First Name

Last Name

Work Phone

Cell Phone

Email

Mother

Title

First Name

Last Name

Work Phone

Cell Phone

Email

Emergency Information

Name Phone # Relation

*Preferred

Secondary

Enrollment Options 2019

Once again, rates are the same as last year!

Register early and save up to 20%!

Sessions






*Tuition (note above days of the week choices)

Early Care

After Care


Total Amount:

The above fees will be charged in full to the card below upon acceptance of your child (usually within 5 days). Please contact us to make other payment arrangements.

Payment Information

Only the non refundable registration fee will automatically be charged at this time.

Registration Fee

*Card Type

*Card Number

*Expiration Date

*Security Code

Use Information above

Name on Card

*Billing Address

*Billing Zip code

I agree to the terms and conditions above

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