2019 Registration

Child's Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Mother's Name

First Name

Last Name

Phone

(###)

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Father's Name

First Name

Last Name

Phone

(###)

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Please Select All Weeks Your Child Will Be Participating *

My Child(ren) Will Attend All Eight Weeks

Week 1: June 24-28

Week 2: July 1-5

Week 3: July 8-12

Week 4: July 15-19

Week 5: July 22-26

Week 6: July 29-August 2

Week 7 July 30-August 3

Week 8 August 6-10

EMERGENCY CONTACT (other than parent/guardian) *

First Name

Last Name

Phone *

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