Child' s Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

ABS Student *

YES

NO

Parent 1 Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent 2 Name *

First Name

Last Name

Phone *

(###)

###

####

Address (If different) *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Pick session(s) *

Session 1 - July 1 to July 5

Session 2 - July 8 to July 12

Session 3 - July 15 to July 19

Session 4 - July 22 to July 26

Session 5 - July 29 to 2

Session 6 - August 5 to 9

Pick Schedule *

5 days a week - 8:00 am to 5:00 pm

5 days a week - 8:30 am to 3:30 pm

3 days a week - 8:00 am to 5:00 pm

3 days a week - 8:30 am to 3:30 pm

2 days a week - 8:00 am to 5:00 pm

2 days a week - 8:30 am to 3:30 pm