Registrant's Information

Parent Name *

Street Address *

City *

State *

Zip Code *

Home Phone *

Cell Phone

Contact's Email *

Emergency Contact (Other than parent) *

Emergency Contact Phone *

Relationship

Child #1 Name *

Grade Level: 1-2 3-4 *

Please Check the Week(s) Attending June 3-6 June 10-13

Child #2 Name

Grade Level: 1-2 3-4

Please Check the Week(s) Attending June 3-6 June 10-13

Child #3 Name

Grade Level: 1-2 3-4

Please Check the Week(s) Attending June 3-6 June 10-13

Child #4 Name

Grade Level: 1-2 3-4

Please Check the Week(s) Attending June 3-6 June 10-13

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