Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

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Child's Name *

First Name

Last Name

Sessions *

I am interested in these sessions:

Week 1: starts June 16

Week 2: starts June 23

Week 3: starts June 30

Week 4: starts July 7

Week 5: starts July 14

Week 6: starts July 21

Week 7: starts July 28

Week 8: starts August 1

Activity Concentration Areas *

Indicate which activity concentration areas your child might have interest in. (Check all that apply.)

Theater

Music

Arts & Crafts

Gardening, Cooking, Food & the Food System

Adventure Play

Sports & Field Games

Session Choice *

Full Day

Half Day

Number of Days *

4 Days/Week

3 Days/Week