Camper Information Dates June 24- July 19 Monday - Friday Before care 8-9am $10 a day/$50 a week After care 3:30-5pm $15 a day/$75 a week Number of Children Registering for Early or After Care Camper 1 Name* First Name Last Name Date of Birth* Month Day Year Grade My child/children will be attending:* Before CareAfter Care Attending Before Care:* DailyWeekly Attending After Care:* DailyWeekly Child 1: My child/children will be attending 8am-9am:* June 24June 25June 26June 27June 28July 1July 2July 3July 4July 5July 8July 9July 10July 11July 12July 15July 16July 17July 18July 19 Child 1: My child/children will be attending 8am-9am:* Please select all that apply: Week 1: June 24-28Week 2: July 1-5Week 3: July 8-12Week 4: July 15-19 Child 1: My child/children will be attending 3:30pm-5pm* June 24June 25June 26June 27June 28July 1July 2July 3July 4July 5July 8July 9July 10July 11July 12July 15July 16July 17July 18July 19 Child 1: My child/children will be attending 3:30pm-5pm:* Please select all that apply: Week 1: June 24-28Week 2: July 1-5Week 3: July 8-12Week 4: July 15-19 Camper 2 Name First Name Last Name Date of Birth Month Day Year Grade My child/children will be attending:* Before CareAfter Care Attending Before Care:* DailyWeekly Attending After Care:* DailyWeekly Child 2: My child/children will be attending 8am-9am:* June 24June 25June 26June 27June 28July 1July 2July 3July 4July 5July 8July 9July 10July 11July 12July 15July 16July 17July 18July 19 Child 2: My child/children will be attending 8am-9am:* Please select all that apply: Week 1: June 24-28Week 2: July 1-5Week 3: July 8-12Week 4: July 15-19 Child 2: My child/children will be attending 3:30pm-5pm* June 24June 25June 26June 27June 28July 1July 2July 3July 4July 5July 8July 9July 10July 11July 12July 15July 16July 17July 18July 19 Child 2: My child/children will be attending 3:30pm-5pm:* Please select all that apply: Week 1: June 24-28Week 2: July 1-5Week 3: July 8-12Week 4: July 15-19 Camper 3 Name First Name Last Name Date of Birth Month Day Year Grade My child/children will be attending:* Before CareAfter Care Attending Before Care* DailyWeekly Attending After Care* DailyWeekly Child 3: My child/children will be attending 8am-9am:* June 24June 25June 26June 27June 28July 1July 2July 3July 4July 5July 8July 9July 10July 11July 12July 15July 16July 17July 18July 19 Child 3: My child/children will be attending 8am-9am:* Please select all that apply: Week 1: June 24-28Week 2: July 1-5Week 3: July 8-12Week 4: July 15-19 Child 3: My child/children will be attending 3:30pm-5pm* June 24June 25June 26June 27June 28July 1July 2July 3July 4July 5July 8July 9July 10July 11July 12July 15July 16July 17July 18July 19 Child 3: My child/children will be attending 3:30pm-5pm:* Please select all that apply: Week 1: June 24-28Week 2: July 1-5Week 3: July 8-12Week 4: July 15-19 Parent Information Father's Name First Name Last Name Cell Phone Area Code Phone Number E-mail Mother's Name First Name Last Name Cell Phone Area Code Phone Number E-mail Payment Total $0.00 Yes, I'd like to donate the cost of processing this transaction by adding 2.5% Payment* Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 Expiration Year Notes Submit Should be Empty: This page uses TLS encryption to keep your data secure.