Summer at Action Day • Elementary School 
We are excited for you to join us for our summer camp this year! Please fill out the form FOR EACH INDIVIDUAL CHILD to submit your enrollment. 

All families who enroll by March 1st will have the $100 summer fee credited back to their account!
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Email *
Parent/Guardian First & Last Name: *
Parent/Guardian Phone Number:
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Email Address:
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Home Address:
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2nd Parent/Guardian First & Last Name:
2nd Parent/Guardian Email:
2nd Parent/Guardian Phone Number:
Child's First & Last Name:
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Child's Date of Birth:
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Any known allergies:
I give Action Day permission to apply sunscreen I provide in the PM.(Parents are responsible for application in the AM)
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Child's Grade Level Completed in 2022-23 School Year:
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Please select your child's desired schedule for June 5- 30 below.
If you are paying by week or by day for June, please indicate which weeks/days your child will attend:
Please select your child's desired schedule for July 1- 31 below.
If you are paying by week or by day for July, please indicate which weeks/days your child will attend:
Please select your child's desired schedule for August 1- 11 below.
If you are paying by week or by day for August, please indicate which weeks/days your child will attend:
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