Richman Pre-Teen/Teen Center Summer 2021 Registration
Please complete this form to register your child for our 2021 Summer Program after completing the orientation video.

If you have not watched the orientation video, please follow the link below and make sure to note the orientation code given during the video.

youtube.com/watch?v=X_LH_S_xd7M&t=184s 

SUMMER OPERATION DATES: Tuesday, June 1st- Friday, August 6th

HOURS:  7am-6pm Monday through Friday

COST:

Registration: $30 for 1 child OR $50 for 2 or more children

$70/week for 1st child $60/week for 2nd child

AGES: 5th - 12th Grade

Please read and initial below:
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Email *
ORIENTATION CODE (Please watch video before completing the registration form) *
First Name (Child 1) *
Last Name (Child 1) *
Gender (Child 1) *
Birth Date (Child 1) *
MM
/
DD
/
YYYY
Grade (2021-2022 School Year) *
T Shirt Size (Please order a size up if you are unsure, you will not be able to exchange sizes) *
Race/Ethnicity *
If your child has an accommodation plan with their school please state (IEP, 504 Plan, etc.)
Allergies (Child 1) *
Permission for Doctor/Hospital in the event of an emergency *
Media Permission *
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