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2019 Salam Academy Summer Camp Application
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* Indicates required question
Email
*
Your email
Student Name
*
Your answer
Age
*
Your answer
Grade
*
Choose
K
1
2
3
4
5
6
7
8
Parent Name
*
Your answer
Address
*
Your answer
Email Address
*
Your answer
Phone Number
Your answer
Sessions
*
June 3rd - June 28th ---$375
July 1st - July 26th ------$375
Both June and July----- $500
I am interested in before/after care
*
Yes
No
Maybe
Required
Before Care/ After Care Packages
*
Package #1 (8am-9am, 3pm-4pm) $150 per child/per month
Package #2 (8am-9am, 3pm-5pm) $250 per child/per month
NO
Required
Student Food Allergies
*
Your answer
Medical Concerns
*
Your answer
Authorized Persons for pick up
*
Your answer
Emergency Contacts (Name and Phone #)
*
Your answer
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