ELC Summer Camp Registration-2022

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This registration is for Summer camp at The Elevation Learning Center.
It will be in operation Monday to Thursday from 9am - 2pm for Summer Camp.
Location: 211 Jericho Tpk. Old Westbury NY 11568

Email *

Name of Child (1): *

Date of Birth *

YYYY

Age of Child (1): *

Grade level child will be entering in the 2022-2023 school year. *

Please describe educational concerns for your child if any. (Ex: Please focus on reading, needs enrichment in all subjects. . . etc)

Allergies *

Name of Child (2):

Date of Birth

YYYY

Grade level your child will be entering in the 2022-2023 school year.

Please describe educational concerns for your child if any. (Ex: Please focus on reading, needs enrichment in all subjects. . . etc)

Allergies Child 2

How many weeks will your child be registering for? *

1 WEEK JUNE 27-30

2 WEEKS JUNE 27-JULY 7TH *NOT INCLUDING JULY 4TH

3 WEEKS JUNE 27TH - JULY 14TH *NOT INCLUDING JULY 4TH

4 WEEKS JUNE 27TH - JULY 21TH *NOT INCLUDING JULY 4TH

Required

Parent/Guardian's Name:

Parent Email: *

Phone Number: *

Home Address *

Emergency Contact: (Name/Relationship to Child/Contact) *

Emergency Contact Phone Number *

Payment *

I would like to pay electronically.

I will be paying by check, made out to "The Elevation Learning Center LLC"

I will be paying with cash.

Best time to call to finalize registration & payment. *

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