Section 1: Parent / Guardian Information
Parent 1 *
Parent 1
Parent 2
Parent 2
Address *
Address
Phone 1 *
Phone 1
Phone 2 *
Phone 2
Emergency Contact
Section 2: Student Information
Student *
Student
Date of Birth *
Date of Birth
Food Allergy *
If "Yes" please describe food allergy (i.e. peanuts) or other dietary needs
Select either Morning or Afternoon Session. All sessions meet Monday - Friday.
Special Program (Optional)