Student First Namerequired

Student Last Namerequired

Grade Fall 2023required

Genderrequired

Date of Birthrequired

Current Schoolrequired

Address 1required

Address 2

Cityrequired

Staterequired

Ziprequired

Parent 1 Namerequired

Emailrequired

Phonerequired

Parent 2 Name

Email

Phone

Half Day Option-$200.00 per week- Check all that Apply

Week 1 June 5-9 Week 2 June 13-16 ($160) Week 3 June 20-23 ($160) Week 4 June 26-June 30 Week 5 July 3-7 ($160) Week 6 July 10-14 Week 7 July 17-21

Full Day Option-$375 per week- Check all that Apply

Week 1 June 5-9 Week 2 June 13-16 ($300) Week 3 June 20-23 ($300) Week 4 June 26- June 30 Week 5 July 3-7 ($300) Week 6 July 10-14 Week 7 July 17-21

Half Day Option (Times below include early morning and late afternoon care if needed)

Please select which session will your child be attending.

Morning 7:30am-12:30pm Afternoon 12:30pm-5:30pm

Total Amount Duerequired

Preferred Method of Payment

Paper check