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Summer Buddies Registration 2022
This form is for registering your child/children for our 2022 session. Please complete all that applies and feel free to email us if you have any questions that come up as you fill it out.
Summerbuddiesinc@gmail.com
If you are applying for funding through the My Turn Program please send us an email after you submit so we can get you an invoice ASAP to get that process going.
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* Indicates required question
Child's Name:
Your answer
Gender
*
Your answer
Age:
*
Choose
3
4
5
6
7
Child 2's Name:
Your answer
Gender
*
Your answer
Age:
Choose
3
4
5
6
7
Child 3's Name:
Your answer
Gender
*
Your answer
Age:
Choose
3
4
5
6
Parent/Caregiver Name(s)
*
Your answer
Parent/Caregiver(s) phone (Please enter all important numbers, i.e. Mom, Dad, Grandma, etc)
*
Your answer
Parent/Caregiver(s) Email Address (Please any/all email address' you'd like to receive correspondence, i.e. Mom, Dad, Grandma, etc)
*
Your answer
Home Address:
*
Your answer
School (and program if applicable) your child last attended:
*
Your answer
Does your child have a disability? If yes, please provide details.
*
Your answer
I know I am registering for the following dates/times
*
July 11-July 22, 2022 from 9AM-12pm
Required
Anticipated Missed Dates:
Your answer
Payment Type you intend to use for the full tuition- You must pay the registration fee at this time to reserve a space for your child
*
Out of Pocket (Cash, credit card or Check made out to Summer Buddies INC. )
My Turn Program Funding through MCDHHS
I'm not sure, I might need some help with this. (Please send a separate email about this so we can find a time to discuss it)
Other:
To complete your registration, please send the $100 registration fee payment to paypal using our email address
summerbuddiesinc@gmail.com
Please enter your name below as a signature to indicate the registration fee has been paid.
*
Your answer
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