SUMMER APPLICATION 2011 

(This section must be filled out for Summer Enrichment/Childcare and Summer Camp children) First come/first spot. 

Childs Name:________________________________________

Birth date:_________________________________________

Parents Name(s):_____________________________________

  Address/city/zip:____________________________________

__________________________________________________

   Email address:________________________________

Phone number #1:______________Phone #2_____________

Emergency Contact #1 (name/phone numbers)______________

________________________________________________

Emergency Contact #2(name/phone numbers)_______________

________________________________________________

Special conditions/allergies:____________________________

Enrichment only:  Days needed with times (this includes any family that needs temporary childcare until schools are out)

m    t    w   th    f   (please circle)   times:________________

vacation dates if applicable:__________________________

SUMMER CAMP INTEREST:  ($10.00 REGISTRATION fee is required for each camp.  Please limit only two camps per child) You will be notified about registration acceptance. 

  If signing up for more than one camp...please indicate 1st choice, 2nd choice or 3rd due to availablility)

CAMP 1:  (Olympic Camp)_____________________name

  yes...I would like my child to attend Olympic Camp June 20-23)

CAMP 2:  (Science Camp)_____________________name

  yes...I would like my child to attend Science Camp July 11-14)

CAMP 3:  (Cooking Camp)_____________________name

  Yes...I would like my child to attend Cooking Camp Aug 1-4)

 OFFICE ONLY:

folder on file:__________________camp registration fee paid:__________#_______

 accepted for enrichment:

 accepted for camp 1 2 3: