Student Information
Last Name:
Grade:
 (from Sept)
School:
Parent Information
First Name:
Last Name:
Phone:
Alternate Phone:
Email:

Address:
City:
State:
Zip Code:
Daily Camp Schedule
Drop off Time Morning Session Lunch Break Afternoon Session Activity Pickup
8:30 AM - 9:00 AM 9:00 - 12:00 PM 12:00 - 1:00 PM 1:00 - 4:00 PM 4:00 - 5:00 PM 5:00 - 5:30 PM

Choose Courses ** (Please select the location to see the list of courses available for each week.)
Week Location Course Price
Week 1 (6/18 to 6/22)
Week 2 (6/25 to 6/29)
Week 3 (7/2 to 7/6)
Week 4 (7/9 to 7/13)
Week 5 (7/16 to 7/20)
Week 6 (7/23 to 7/27)
Week 7 (7/31 to 8/3)
Week 8 (8/6 to 8/10)
Week 9 (8/13 to 8/17)
Total:

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