Child’s Name *

First Name

Last Name

Childs Date Of Birth

MM

DD

YYYY

Mother’s Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Father’s Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

What weeks will your child attend?

June 23 - 27

June 30- July 4

July 7 - July 11

July 14 - July 18

July 21 - 25

July 28 - August 1

August 4 - August 8

August 11 - August 15

August 18 - August 22