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2023 SUMMER KIDS CLUB APPLICATION
Please complete this form for each child, we need individual information for every child.
You must agree to the Code of Conduct and agree in order to be registered.
Once you register you will recieve information about this year's program.
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* Indicates required question
Childs First name
*
Your answer
Child's last name
*
Your answer
gender
*
Choose
FEMALE
MALE
RATHER NOT DAY
GRADE IN FALL
*
Choose
1
2
3
4
5
6
7
PARENT NAME
*
Your answer
MAILING ADDRESS
*
Your answer
TOWN
*
Your answer
BEST PHONE TO REACH DURING DAY
*
Your answer
2nd BEST PHONE to REACH DURING DAY
*
Your answer
3rd best phone
Your answer
best email
*
Your answer
2nd best email
Your answer
allergies
*
Your answer
medical conditions
*
Your answer
Who can pick child up
*
Your answer
Day of week you plan on attending
This does not lock you in to only those day. Allows a chance to staff
Monday
Tuesday
Wednesday
Thursday
Friday
What weeks are you planning on attending
This doesn't lock you in or making a committment gives us a idea for staffing.
Week 1 6/19-6/23
Week 2 6/26-6/30
Week 3 7/5-7-7 (No programs Monday or Tuesday)
Week 4 7/10-7/14
Week 5 7/17-7/21
Week 6 7/24-7/28
Week 7 7/31-8/4
Week 8 8/7-8/11
Do you want to take swim lessons session 1
SESSION 1 SWIM LESSONS WILL JUNE 26 TO JULY 21
LEVEL 1
LEVEL 2
LEVEL 3
LEVEL 4
LEVEL 5
Option 2
Clear selection
Do you want to take swim lessons session 2
SESSION 2 SWIM WILL BE JULY 24 TO AUGUST 11
LEVEL 1
LEVEL 2
LEVEL 3
LEVEL 4
LEVEL 5
Option 2
Clear selection
Do you want to DO KIDS COOKING PROGRAM
This will cost $25.00 extra for this week. Classes are limited to 8 participants
You may sign up for only 1 class.
Choose
July 10-13--9:00am Grades 3-4
July 10-13--10:00am Grades 5-6-7-8
August 7-10 9:00am Grades 3-4
August 7-10 10:00am Grades 5-6-7-8
AGREEMENT TO CODE OF CONDUCT
Choose
I AGREE TO THE TERMS OF THE CODE OF CONDUCT
Submit
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