Information Form: Summer Day Camp

• Are you requesting information for:

  Your Child

  Someone Else's Child

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  Make Required
  
  Your Child,Someone Else's Child
• What Grade is your Child Current Enrolled in School

  Pre-K

  Kindergarden

  1st Grade

  2nd Grade

  3rd Grade

  4th Grade

  5th Grade

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  Make Required
  
  Pre-K,Kindergarden,1st Grade,2nd Grade,3rd Grade,4th Grade,5th Grade
• Child First Name

  Child Last Name
  

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  Make Required
• 2nd Child First Name

  2nd Child Last Name
  2nd Child Birthday
  Add Another Participant
  
• Parent First Name

  Parent Last Name
  

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  Make Required
• Your Relationship to Child

  Mother

  Father

  Grandparent

  Friend

  Other

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  Make Required
  
  Mother,Father,Grandparent,Friend,Other
• Email Address

  

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  Make Required
• Mobile Phone
  

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  Make Required
• What specifically would you like your child to accomplish in our summer camp?
  

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  Make Required
• Please check the benefits most important to you.

  Self-Confidence

  Self Esteem

  Respect

  Improved Behavior

  Physical Fitness

  Weight Control

  Strength & Flexibility

  Coordination

  Focus

  Self-Discipline

  Concentration

  Self-Control

  Burn Energy

  Leadership

  Fun!

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  Make Required
  
  Self-Confidence,Self Esteem,Respect,Improved Behavior,Physical Fitness,Weight Control,Strength & Flexibility,Coordination,Focus,Self-Discipline,Concentration,Self-Control,Burn Energy,Leadership,Fun!

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