2023 Summer Program Application
Dates: June 20th-August 30th
Hours: Preschool (ages 3-4) 9am-12pm
              Cost: 5 days $330/month
                        4 days $300/month
                        3 days $270/month
                        2 days $240/month
             School Age (ages 5-12) 9am-2pm
              Cost: 5 days $530/month
                        4 days $500/month
                        3 days $470/month
                        2 days $440/month
Before and After care available at $5.50/hr
İlerleme durumunu kaydetmek için Google'da oturum açın Daha fazla bilgi
E-posta *
Name of child #1 attending *
Age of child #1 attending *
Gerekli
Child #1 days and times *
AM Care
Full day
PM Care
No Care
Monday
Tuesday
Wednesday
Thursday
Friday
Any additional comments about child one?
Name of child #2 attending
Age of child #2 attending
Child #2 days and times
AM Care
Full day
PM Care
No care
Monday
Tuesday
Wednesday
Thursday
Friday
Any additional comments about child two?
Name of child #3 attending
Age of child #3 attending
Child #3 days and times
AM Care
Full day
PM Care
No care
Monday
Tuesday
Wednesday
Thursday
Friday
Any additional comments about child three?
My child _______(type child's name below)______ has my permission to walk with ABC Educational Center Staff and Students to nearby locations throughout the Summer (June-August 2022).
 *
I have provided a bottle of sunscreen labeled with my child’s name and give ABC Educational Center staff permission to apply the sunscreen throughout the summer, as needed. _____ (initial)
 *
In an emergency, ABC Educational Center has my permission to call an ambulance, or take my child to any available physician or hospital at my expense to obtain medical treatment. The parent or guardian will be notified as soon as possible.  ______ (initial)
 *
Emergency Contact Name and Relationship
 *
Emergency Contact Phone Number
 *
Signed by, and relationship
 *
Date Signed *
GG
/
AA
/
YYYY
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